Organization
ALLERGY, ASTHMA & IMMUNOLOGY CENTER, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SRIVIDYA SRIDHARA MD (MANAGER/OWNER)
(972) 521-3366
Entity
Organization
Contact information
Practice address
623 W FM 544, STE 104, MURPHY, TX 75094-4577
(972) 521-3366
(972) 422-5656
Mailing address
6210 GEORGIAN CT, DALLAS, TX 75254-8652
(408) 431-0256
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
P4113
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TXB165560
TEXAS MEDICARE IDENTIFICATION NUMBER
TX
Enumeration date
01/17/2014
Last updated
10/28/2024
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