Provider Demographics
NPI:1639062946
Name:TWO RIVERS MEDICAL
Entity type:Organization
Organization Name:TWO RIVERS MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAYA
Authorized Official - Middle Name:KRISHNA
Authorized Official - Last Name:KOLLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-226-0206
Mailing Address - Street 1:2810 MANATEE AVE E
Mailing Address - Street 2:2810 MANATEE AVE E
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1828
Mailing Address - Country:US
Mailing Address - Phone:941-226-0206
Mailing Address - Fax:941-900-1043
Practice Address - Street 1:2810 MANATEE AVE E
Practice Address - Street 2:2810 MANATEE AVE E
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1828
Practice Address - Country:US
Practice Address - Phone:941-226-0206
Practice Address - Fax:941-900-1043
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TWO RIVERS URGENT CARE AND WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty