Provider Demographics
NPI:1346233012
Name:MID VALLEY PEDIATRIC & ALLERGY
Entity Type:Organization
Organization Name:MID VALLEY PEDIATRIC & ALLERGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:REGANT
Authorized Official - Middle Name:V
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-969-2609
Mailing Address - Street 1:1010 S AIRPORT DR
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6647
Mailing Address - Country:US
Mailing Address - Phone:956-969-2609
Mailing Address - Fax:956-973-0413
Practice Address - Street 1:1010 S AIRPORT DR
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6647
Practice Address - Country:US
Practice Address - Phone:956-969-2609
Practice Address - Fax:956-973-0413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7583208000000X
TXK6219208000000X
TXK1893208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8546KIOtherBLUE CROSS BLUE SHIELD
TX081233101Medicaid
B85182Medicare UPIN