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General NPI Number Information
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NPI Number | 1689271009
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Entity Type | Organization
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Legal Business Name | INDIGO BEND, LLC
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Dates
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Enumeration Date | 10/08/2020
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Last Update Date | 10/08/2020
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Provider Practice Location Address
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Address Line | 11212 STATE HIGHWAY 151
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City | SAN ANTONIO
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State | TX
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Zip | 78251-4498
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Country | US
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Telephone | 210-847-1486
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Fax | 210-588-0006
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Provider Business Mailing Address
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Address Line | 2313 LOCKHILL SELMA RD # 621
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City | SAN ANTONIO
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State | TX
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Zip | 78230-3007
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Country | US
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Telephone | 210-847-1486
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Fax | 210-588-0006
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Authorized Official
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Title or Position | PRESIDENT
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Name | MADHU SUDHAN REDDY BADIREDDY
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Credential | MD
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Telephone | 210-847-1486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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