1265572481 NPI number — DR. CHANDRASEKHAR R VASAMREDDY M.D.

Table of content: DR. CHANDRASEKHAR R VASAMREDDY M.D. (NPI 1265572481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265572481 NPI number — DR. CHANDRASEKHAR R VASAMREDDY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VASAMREDDY
Provider First Name:
CHANDRASEKHAR
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265572481
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 MERCY WAY
Provider Second Line Business Mailing Address:
SUITE 320
Provider Business Mailing Address City Name:
JOPLIN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-781-5387
Provider Business Mailing Address Fax Number:
417-781-7174

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 MERCY WAY
Provider Second Line Business Practice Location Address:
SUITE 320
Provider Business Practice Location Address City Name:
JOPLIN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-781-5387
Provider Business Practice Location Address Fax Number:
417-781-7174
Provider Enumeration Date:
02/07/2007

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: 207RC0000X , with the licence number:  24539 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: MO-2009008971 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: KSDEA-FV1379646 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 04-33682 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0001X , with the licence number: 2009008971 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0001X , with the licence number: 04-33682 , 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: 67A00005 . This is a "MEDICARE PTANK" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: K67000014 . This is a "MEDICARE PTAN" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 200611200A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 450D00003D . This is a "MEDICARE JOHNSON COUNTY" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 450A00003A . This is a "MEDICARE JACKSON COUNTY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1265572481 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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