1215935812 NPI number — MRS. SUGUNA V REDDY MD

Table of content: MRS. SUGUNA V REDDY MD (NPI 1215935812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215935812 NPI number — MRS. SUGUNA V REDDY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REDDY
Provider First Name:
SUGUNA
Provider Middle Name:
V
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REDDY
Provider Other First Name:
SUGUNA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215935812
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 W CENTRAL AVE
Provider Second Line Business Mailing Address:
STE 108
Provider Business Mailing Address City Name:
EL DORADO
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67042-2184
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-321-7550
Provider Business Mailing Address Fax Number:
316-321-1404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 W CENTRAL AVE
Provider Second Line Business Practice Location Address:
STE 108
Provider Business Practice Location Address City Name:
EL DORADO
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67042-2184
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-321-7550
Provider Business Practice Location Address Fax Number:
316-321-1404
Provider Enumeration Date:
07/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  18326 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100194400A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 617610 . This is a "HEALTHWAVE" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com