1487972279 NPI number — MADHURI SEGIREDDY MD PC

Table of content: (NPI 1487972279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487972279 NPI number — MADHURI SEGIREDDY MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MADHURI SEGIREDDY MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1487972279
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4022 E PRESIDIO ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85215-1113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-985-1093
Provider Business Mailing Address Fax Number:
480-296-7643

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
485 S DOBSON RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
CHANDLER
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85224-5602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-855-0421
Provider Business Practice Location Address Fax Number:
480-855-0467
Provider Enumeration Date:
05/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SEGIREDDY
Authorized Official First Name:
MADHURI
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
480-202-6660

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 438501 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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