NPIMap

Organization Active NPI

Doctors Clinic of Durant Inc

  • Family Medicine Physician
  • Durant, OK
National Provider Identifier
1598850331
Registry record updated Dec 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
11978 Issued in OK
Legal business name
DOCTORS CLINIC OF DURANT INC
Practice address
1400 Bryan Dr
Suite 300
Durant, OK 74701-2156
Phone
(580) 924-1700
Fax
(580) 924-1736
NPI assigned
Oct 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Koteswar Rao Sureddi, MDNPI 1780621052
Title
Owner
Phone
(580) 924-1700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 11978 OK Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 23224 OK
Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VG0400X 11979 OK
Medical Specialty Clinic/Center 261QM2500X OK

Addresses

Primary practice location

1400 Bryan Dr
Suite 300
Durant, OK 74701-2156

Mailing address

1400 Bryan Dr
Suite 300
Durant, OK 74701
Phone (580) 924-1700

Other identifiers 3

IdentifierTypeStateIssuer
100733950BMedicaidOK
200076210GMedicaidOK
100177390AMedicaidOK

National Provider Directory

National Provider Directory
Tax ID family
Doctors Clinic of Durant Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291939200000",
    "number": "1598850331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 BRYAN DR",
            "address_2": "SUITE 300",
            "city": "DURANT",
            "state": "OK",
            "postal_code": "74701",
            "telephone_number": "580-924-1700",
            "fax_number": "580-924-1736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 BRYAN DR",
            "address_2": "SUITE 300",
            "city": "DURANT",
            "state": "OK",
            "postal_code": "747012156",
            "telephone_number": "580-924-1700",
            "fax_number": "580-924-1736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOCTORS CLINIC OF DURANT INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2010-12-10",
        "status": "A",
        "authorized_official_last_name": "SUREDDI",
        "authorized_official_first_name": "KOTESWAR",
        "authorized_official_middle_name": "RAO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "580-924-1700",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "11978",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "OK",
            "license": "23224",
            "primary": false
        },
        {
            "code": "207VG0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "OK",
            "license": "11979",
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "OK",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100733950B",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200076210G",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100177390A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Durant, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.