Provider Demographics
NPI:1942465729
Name:VISWANATHA REDDY YARATHA, MD
Entity Type:Organization
Organization Name:VISWANATHA REDDY YARATHA, MD
Other - Org Name:LEA COUNTY CHILDREN'S CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VISWANATHA
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:YARATHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-392-1503
Mailing Address - Street 1:5419 N LOVINGTON HWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-9131
Mailing Address - Country:US
Mailing Address - Phone:575-392-1503
Mailing Address - Fax:
Practice Address - Street 1:5419 N LOVINGTON HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-9131
Practice Address - Country:US
Practice Address - Phone:575-392-1503
Practice Address - Fax:575-392-5698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM83-345208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM24778Medicaid
NM24778Medicaid