Provider Demographics
NPI:1073026704
Name:VALLEY RANCH INTERNAL MEDICINE, PLLC
Entity type:Organization
Organization Name:VALLEY RANCH INTERNAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:VIJAYA SHREE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHINTALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-505-3401
Mailing Address - Street 1:9901 VALLEY RANCH PKWY E STE 2073
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-7191
Mailing Address - Country:US
Mailing Address - Phone:972-505-3401
Mailing Address - Fax:214-377-8833
Practice Address - Street 1:9901 VALLEY RANCH PKWY E STE 2073
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-7191
Practice Address - Country:US
Practice Address - Phone:972-505-3401
Practice Address - Fax:214-377-8833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-16
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8598207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX195129501Medicaid