Provider Demographics
NPI:1750515532
Name:G. S. BINDRA, M.D., PLLC
Entity type:Organization
Organization Name:G. S. BINDRA, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:BINDRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-286-0149
Mailing Address - Street 1:260 OAK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-0701
Mailing Address - Country:US
Mailing Address - Phone:731-286-0149
Mailing Address - Fax:731-334-5041
Practice Address - Street 1:315 E TICKLE ST STE A
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-3117
Practice Address - Country:US
Practice Address - Phone:731-286-0149
Practice Address - Fax:731-334-5041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-08
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21989174400000X
207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ002829Medicaid
TN3064931Medicaid
1750515532OtherGROUP NPI
1093716490OtherINDIVIDUAL NPI