Provider Demographics
NPI:1295018182
Name:VYSHALI REDDY LOUPE, MD, LLC
Entity Type:Organization
Organization Name:VYSHALI REDDY LOUPE, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:NEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-218-3856
Mailing Address - Street 1:PO BOX 1050
Mailing Address - Street 2:380 WOODS COVE ROAD
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-1050
Mailing Address - Country:US
Mailing Address - Phone:256-218-3856
Mailing Address - Fax:256-218-3536
Practice Address - Street 1:331 PARKS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-2411
Practice Address - Country:US
Practice Address - Phone:256-259-1635
Practice Address - Fax:256-259-1685
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JACKSON COUNTY HEALTH CARE AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30028207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty