Provider Demographics
NPI:1225369226
Name:REKHA POLE ASSOCIATES P A
Entity Type:Organization
Organization Name:REKHA POLE ASSOCIATES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-369-5522
Mailing Address - Street 1:16901 DALLAS PKWY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-5226
Mailing Address - Country:US
Mailing Address - Phone:214-369-5522
Mailing Address - Fax:214-369-5327
Practice Address - Street 1:16901 DALLAS PKWY
Practice Address - Street 2:SUITE 106
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-5226
Practice Address - Country:US
Practice Address - Phone:214-369-5522
Practice Address - Fax:214-369-5327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG54902084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX098059101Medicaid
TXC20563Medicare UPIN