Provider Demographics
NPI:1902120132
Name:REDDY FAMILY MEDICAL CLINIC LLC
Entity Type:Organization
Organization Name:REDDY FAMILY MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NAGARATNA
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-473-3931
Mailing Address - Street 1:217 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:DONALDSONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70346-2527
Mailing Address - Country:US
Mailing Address - Phone:225-473-3931
Mailing Address - Fax:225-473-3289
Practice Address - Street 1:217 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:DONALDSONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70346-2527
Practice Address - Country:US
Practice Address - Phone:225-473-3931
Practice Address - Fax:225-473-3289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05775R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1948144Medicaid
LA1948144Medicaid
LA193813Medicare PIN