Provider Demographics
NPI:1427240209
Name:SHRIKANT RISHI, M.D., M.S., F.A.C.S.
Entity type:Organization
Organization Name:SHRIKANT RISHI, M.D., M.S., F.A.C.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHRIKANT
Authorized Official - Middle Name:K
Authorized Official - Last Name:RISHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-634-0145
Mailing Address - Street 1:2207 S CLEAR CREEK RD
Mailing Address - Street 2:STE # 303
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-4132
Mailing Address - Country:US
Mailing Address - Phone:254-634-0145
Mailing Address - Fax:254-634-1987
Practice Address - Street 1:2207 S CLEAR CREEK RD
Practice Address - Street 2:STE # 303
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4132
Practice Address - Country:US
Practice Address - Phone:254-634-0145
Practice Address - Fax:254-634-1987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMDL5535207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158201701Medicaid
TX0071JTOtherBLUE CROSS BLUE SHIELD
TX207463764OtherTRICARE
TXD35202Medicare UPIN