Provider Demographics
NPI:1750340097
Name:KRISHNA REDDY & RAMA D NAYINI,PTR-EAST TEXAS HEART & LUNG CLINIC
Entity type:Organization
Organization Name:KRISHNA REDDY & RAMA D NAYINI,PTR-EAST TEXAS HEART & LUNG CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMA
Authorized Official - Middle Name:DEVI
Authorized Official - Last Name:NAYINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-236-3773
Mailing Address - Street 1:915 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5416
Mailing Address - Country:US
Mailing Address - Phone:903-236-3773
Mailing Address - Fax:903-236-3779
Practice Address - Street 1:915 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5416
Practice Address - Country:US
Practice Address - Phone:903-236-3773
Practice Address - Fax:903-236-3779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0494207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0000SN74OtherBLUE CROSS & BLUE SHIELD
TX00SN74Medicare ID - Type UnspecifiedMEDICARE
TXCU0304Medicare ID - Type UnspecifiedMEDICARE/RAILROAD