Provider Demographics
NPI:1518363993
Name:LONE STAR GASTROENTEROLOGY OF ABILENE, PLLC
Entity Type:Organization
Organization Name:LONE STAR GASTROENTEROLOGY OF ABILENE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MANAGING MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVEK REDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARLAPATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-864-0209
Mailing Address - Street 1:PO BOX 6815
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79608-6815
Mailing Address - Country:US
Mailing Address - Phone:325-704-5055
Mailing Address - Fax:325-704-5056
Practice Address - Street 1:1904 PINE ST STE 1B
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601
Practice Address - Country:US
Practice Address - Phone:325-704-5055
Practice Address - Fax:325-704-5056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-12
Last Update Date:2018-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP8475207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX343750101Medicaid