Provider Demographics
NPI:1891984043
Name:KOTA JAGDISH REDDY MD PA
Entity Type:Organization
Organization Name:KOTA JAGDISH REDDY MD PA
Other - Org Name:REDDY & REYNOLDS CARDIOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KOTA
Authorized Official - Middle Name:J
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-491-0044
Mailing Address - Street 1:P.O.BOX 2566
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77487-2566
Mailing Address - Country:US
Mailing Address - Phone:281-491-0044
Mailing Address - Fax:281-491-1447
Practice Address - Street 1:3519 TOWN CENTER BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-1001
Practice Address - Country:US
Practice Address - Phone:281-491-0044
Practice Address - Fax:281-491-1447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2568174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1275565236OtherINDIVIDUAL NPI
TX154455301Medicaid
TX060070154OtherMEDICARE RAILROAD INDIVIDUAL
1376554691OtherINDIVIDUAL NPI
TXDD6476OtherMEDICARE RAILROAD GROUP
1376554691OtherINDIVIDUAL NPI
TX154455301Medicaid