Provider Demographics
NPI:1528248242
Name:REDDY RHEUMATOLOGY OF NORTHWEST IN PC
Entity type:Organization
Organization Name:REDDY RHEUMATOLOGY OF NORTHWEST IN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:LONGACRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-736-2922
Mailing Address - Street 1:118 E 90TH DRIVE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7160
Mailing Address - Country:US
Mailing Address - Phone:219-736-2922
Mailing Address - Fax:219-736-2938
Practice Address - Street 1:118 E 90TH DRIVE
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7160
Practice Address - Country:US
Practice Address - Phone:219-736-2922
Practice Address - Fax:219-736-2938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
01056231A207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000322080OtherANTHEM
IN200806960Medicaid
INP00173282OtherRAILROAD MEDICARE
IN216920AMedicare PIN
ING12919Medicare UPIN