Provider Demographics
NPI:1235226713
Name:INFECTIOUS DISEASES ASSOCIATES, LLP
Entity Type:Organization
Organization Name:INFECTIOUS DISEASES ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:KESHAVA
Authorized Official - Middle Name:C
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-892-6099
Mailing Address - Street 1:3030 NORTH ST
Mailing Address - Street 2:SUITE 460
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702
Mailing Address - Country:US
Mailing Address - Phone:409-892-6099
Mailing Address - Fax:409-892-2210
Practice Address - Street 1:3030 NORTH ST
Practice Address - Street 2:SUITE 460
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702
Practice Address - Country:US
Practice Address - Phone:409-892-6099
Practice Address - Fax:409-892-2210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RI0200X
TXJ4983207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00073NOtherBLUE CROSS BLUE SHIELD
TX079781301Medicaid
TX00073NOtherBLUE CROSS BLUE SHIELD