1891984043 NPI number — KOTA JAGDISH REDDY MD PA

Table of content: (NPI 1891984043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891984043 NPI number — KOTA JAGDISH REDDY MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KOTA JAGDISH REDDY MD PA
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:
6
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:
1891984043
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O.BOX 2566
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77487-2566
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-491-0044
Provider Business Mailing Address Fax Number:
281-491-1447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3519 TOWN CENTER BLVD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SUGAR LAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77479-1001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-491-0044
Provider Business Practice Location Address Fax Number:
281-491-1447
Provider Enumeration Date:
10/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
REDDY
Authorized Official First Name:
KOTA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
281-491-0044

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  K2568 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1275565236 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 154455301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060070154 . This is a "MEDICARE RAILROAD INDIVIDUAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1376554691 . This is a "INDIVIDUAL NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: DD6476 . This is a "MEDICARE RAILROAD GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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