Provider Demographics
NPI:1487872362
Name:REDDY CHILDRENS CLINIC, P.A
Entity type:Organization
Organization Name:REDDY CHILDRENS CLINIC, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SURAPUREDDY
Authorized Official - Middle Name:SEETHARAM
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-425-4700
Mailing Address - Street 1:1821 S SESAME SQ
Mailing Address - Street 2:SUITE#8
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-9288
Mailing Address - Country:US
Mailing Address - Phone:956-425-4700
Mailing Address - Fax:956-425-6260
Practice Address - Street 1:1821 S SESAME SQ
Practice Address - Street 2:SUITE#8
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-9288
Practice Address - Country:US
Practice Address - Phone:956-425-4700
Practice Address - Fax:956-425-6260
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REDDY CHILDRENS CLINIC, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-23
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0535208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123984OtherSUPERIOR HEALTH PLAN
TX129771101OtherVALLEY HEALTH PLANS
TX8K9920OtherBCBSTX
TX043239502Medicaid
TX043239502Medicaid