Provider Demographics
NPI:1003990821
Name:SREENU ADA,MD,PC
Entity Type:Organization
Organization Name:SREENU ADA,MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SREENU
Authorized Official - Middle Name:
Authorized Official - Last Name:ADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-496-8328
Mailing Address - Street 1:PO BOX 270653
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-0653
Mailing Address - Country:US
Mailing Address - Phone:314-496-8328
Mailing Address - Fax:636-333-4510
Practice Address - Street 1:10018 KENNERLY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2106
Practice Address - Country:US
Practice Address - Phone:636-465-0544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SREENU ADA,MD,PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-25
Last Update Date:2023-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003023195207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000015082Medicare ID - Type UnspecifiedMC GROUP