Provider Demographics
NPI:1073644852
Name:AIRLINE PEDIATRICS, P.A.
Entity Type:Organization
Organization Name:AIRLINE PEDIATRICS, P.A.
Other - Org Name:SURESH N. PATHIKONDA, M.D, P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:N
Authorized Official - Last Name:PATHIKONDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:361-575-8500
Mailing Address - Street 1:601 E AIRLINE RD
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-3926
Mailing Address - Country:US
Mailing Address - Phone:361-575-8500
Mailing Address - Fax:361-575-8416
Practice Address - Street 1:601 E AIRLINE RD
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-3926
Practice Address - Country:US
Practice Address - Phone:361-575-8500
Practice Address - Fax:361-575-8416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0039AZOtherBCBS GROUP
TX079684901Medicaid
TX079684902Medicaid
TX079684901Medicaid