=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255617833
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REDBUD PEDIATRICS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2011
-----------------------------------------------------
Last Update Date | 05/27/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8725 E 32ND ST N
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67226-4008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-201-1202
-----------------------------------------------------
Fax | 316-201-1251
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8725 E 32ND ST N
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67226-4008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-201-1202
-----------------------------------------------------
Fax | 316-201-1251
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. REBECCA H REDDY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 316-201-1202
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------