Provider Demographics
NPI:1134381999
Name:NAGIREDDI PEDIATRICS LLC
Entity type:Organization
Organization Name:NAGIREDDI PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:VENKATA
Authorized Official - Middle Name:SATYANARAYANA
Authorized Official - Last Name:NAGIREDDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-937-2755
Mailing Address - Street 1:1463 HIGHWAY 61
Mailing Address - Street 2:SUITE # C
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4109
Mailing Address - Country:US
Mailing Address - Phone:636-937-2755
Mailing Address - Fax:636-933-2910
Practice Address - Street 1:1463 HIGHWAY 61
Practice Address - Street 2:SUITE # C
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4109
Practice Address - Country:US
Practice Address - Phone:636-937-2755
Practice Address - Fax:636-933-2910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004006669208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty