Provider Demographics
NPI:1427006295
Name:NAIDU CLINIC
Entity Type:Organization
Organization Name:NAIDU CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RITTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-334-8088
Mailing Address - Street 1:605 E 4TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-5100
Mailing Address - Country:US
Mailing Address - Phone:432-337-4347
Mailing Address - Fax:432-337-1657
Practice Address - Street 1:605 E 4TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5100
Practice Address - Country:US
Practice Address - Phone:432-337-4347
Practice Address - Fax:432-337-1657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0031BHMedicare ID - Type UnspecifiedGROUP NUMBER