Provider Demographics
NPI:1255419404
Name:NAGA S TRIPURANENI
Entity type:Organization
Organization Name:NAGA S TRIPURANENI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALLING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:P
Authorized Official - Last Name:RICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-465-1857
Mailing Address - Street 1:PO BOX 2275
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75021-2275
Mailing Address - Country:US
Mailing Address - Phone:903-465-1857
Mailing Address - Fax:903-327-8023
Practice Address - Street 1:1014 MEMORIAL DR STE G12
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-2090
Practice Address - Country:US
Practice Address - Phone:903-465-1857
Practice Address - Fax:903-327-8023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8985174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C0639Medicare ID - Type Unspecified
TXI099258Medicare UPIN