Provider Demographics
NPI:1568705598
Name:CHIPOLA SURGICAL AND MEDICAL SPECIALTIES
Entity Type:Organization
Organization Name:CHIPOLA SURGICAL AND MEDICAL SPECIALTIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MURALI KRISHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADDIPATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-254-2645
Mailing Address - Street 1:2946 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-3140
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2946 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-3140
Practice Address - Country:US
Practice Address - Phone:850-526-3314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ER PHYSICIANS GROUP AT JACKSON HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106347332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054877400Medicaid
FL054877400Medicaid