Provider Demographics
NPI:1699950733
Name:SRI MD, INC
Entity type:Organization
Organization Name:SRI MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SREEKANTH
Authorized Official - Middle Name:
Authorized Official - Last Name:GANAPAVARAPU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-229-7500
Mailing Address - Street 1:8383 SVL BOX
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5168
Mailing Address - Country:US
Mailing Address - Phone:909-229-7500
Mailing Address - Fax:909-563-8447
Practice Address - Street 1:18564 HIGHWAY 18
Practice Address - Street 2:SUITE# 105
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2312
Practice Address - Country:US
Practice Address - Phone:760-242-7777
Practice Address - Fax:909-563-8447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82967282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA082967Medicaid
CAH98538Medicare UPIN
CA082967Medicaid