Provider Demographics
NPI:1578514535
Name:T & R CLINIC A PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:T & R CLINIC A PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUCHITA
Authorized Official - Middle Name:D
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-831-0321
Mailing Address - Street 1:2919 MARKUM DRIVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76117-4004
Mailing Address - Country:US
Mailing Address - Phone:817-831-0321
Mailing Address - Fax:817-831-3211
Practice Address - Street 1:2919 MARKUM DRIVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76117-4004
Practice Address - Country:US
Practice Address - Phone:817-831-0321
Practice Address - Fax:817-831-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1311207Q00000X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX92104103Medicaid
TXCP0037OtherRAILROAD MEDICARE
TX92104103Medicaid