Provider Demographics
NPI:1457867905
Name:SIVAKOTI R KATTA, LLC
Entity Type:Organization
Organization Name:SIVAKOTI R KATTA, LLC
Other - Org Name:SIVAKOTI R KATTA, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SIVAKOTI
Authorized Official - Middle Name:
Authorized Official - Last Name:KATTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-499-8091
Mailing Address - Street 1:8919 PARALLEL PKWY STE 215
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66112-1682
Mailing Address - Country:US
Mailing Address - Phone:913-499-8091
Mailing Address - Fax:913-499-7440
Practice Address - Street 1:8919 PARALLEL PKWY STE 215
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-1655
Practice Address - Country:US
Practice Address - Phone:913-499-8091
Practice Address - Fax:913-499-7440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-20
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100206070BMedicaid