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General NPI Number Information
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NPI Number | 1467883694
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Entity Type | Organization
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Legal Business Name | SR MEDICAL CLINIC PLLC
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Dates
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Enumeration Date | 12/13/2013
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Last Update Date | 03/25/2014
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Provider Practice Location Address
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Address Line | 5990 AIRLINE DR 250
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City | HOUSTON
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State | TX
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Zip | 77076-4237
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Country | US
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Telephone | 713-695-8180
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 38252
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City | HOUSTON
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State | TX
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Zip | 77238-8252
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | SADASIVAREDDY GOLI
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Credential | MD
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Telephone | 713-695-8180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | L3314
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License Number State | TX
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