=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982628160
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SWAROOP A.V.N REDDY M.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2002 HOLCOMBE BLVD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-4211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-791-1414
-----------------------------------------------------
Fax | 713-794-7838
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21410 GANTON DR
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77450-5095
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-578-2468
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282NC0060X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital
-----------------------------------------------------
License Number | G4199
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------