Basic Information
| Provider Information | |||||||||
| NPI: | 1003990821 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SREENU ADA,MD,PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18 VANDIVER LN | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631311107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144968328 | ||||||||
| FaxNumber: | 6363334510 | ||||||||
| Practice Location | |||||||||
| Address1: | 1390 HIGHWAY 61 STE 3200 | ||||||||
| Address2: | |||||||||
| City: | FESTUS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630284121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6364650544 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 06/02/2020 | ||||||||
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| AuthorizedOfficialLastName: | ADA | ||||||||
| AuthorizedOfficialFirstName: | SREENU | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3144968328 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SREENU ADA,MD,PC | ||||||||
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| NPICertificationDate: | 06/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2003023195 | MO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.