Provider Demographics
NPI:1922592658
Name:ALLERGY RHEUMATOLOGY IMMUNOLOGY ASSOCIATES OF NORTH TEXAS ARIANT PLLC
Entity Type:Organization
Organization Name:ALLERGY RHEUMATOLOGY IMMUNOLOGY ASSOCIATES OF NORTH TEXAS ARIANT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENUKA
Authorized Official - Middle Name:V
Authorized Official - Last Name:BASAVARAJU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-253-4370
Mailing Address - Street 1:5350 INDEPENDENCE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-4653
Mailing Address - Country:US
Mailing Address - Phone:972-253-4370
Mailing Address - Fax:972-823-6407
Practice Address - Street 1:2021 N MACARTHUR BLVD STE 225
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061
Practice Address - Country:US
Practice Address - Phone:972-253-4370
Practice Address - Fax:972-823-6407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-16
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX047550104Medicaid