Provider Demographics
NPI:1225192768
Name:VALLEY GASTROENTEROLOGY CLINIC, P.A.
Entity type:Organization
Organization Name:VALLEY GASTROENTEROLOGY CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KONDAPAVULURU
Authorized Official - Middle Name:V
Authorized Official - Last Name:CHOWDARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-630-2979
Mailing Address - Street 1:301 LINDBERG AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-2902
Mailing Address - Country:US
Mailing Address - Phone:956-630-2979
Mailing Address - Fax:956-630-1375
Practice Address - Street 1:301 LINDBERG AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-2902
Practice Address - Country:US
Practice Address - Phone:956-630-2979
Practice Address - Fax:956-630-1375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00L25SMedicare ID - Type UnspecifiedMEDICARE