Provider Demographics
NPI:1366727729
Name:THE NAIDU CLINIC, PA
Entity type:Organization
Organization Name:THE NAIDU CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJA
Authorized Official - Middle Name:BAVIKATI
Authorized Official - Last Name:NAIDU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-337-4347
Mailing Address - Street 1:5425 NEW ORLEANS DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-4736
Mailing Address - Country:US
Mailing Address - Phone:432-362-0018
Mailing Address - Fax:
Practice Address - Street 1:605 E 4TH ST STE 300
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5100
Practice Address - Country:US
Practice Address - Phone:432-337-4347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2010011351364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult HealthGroup - Single Specialty