| Sai Vittala Pllc | |
|
5560 Mesa Springs Dr Fort Worth TX 76123-2120 | |
| (817) 292-4600 | |
| Not Available |
| Full Name | Sai Vittala Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 5560 Mesa Springs Dr, Fort Worth, Texas |
| Authorized Official Name and Position | Ramakrishna Veluri (MD) |
| Authorized Official Contact | 6824773534 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sai Vittala Pllc 2600 E Southlake Blvd Ste 120354 Southlake TX 76092-6634 Ph: (682) 477-3534 | Sai Vittala Pllc 5560 Mesa Springs Dr Fort Worth TX 76123-2120 Ph: (817) 292-4600 |
| NPI Number | 1497134332 |
|---|---|
| Provider Enumeration Date | 05/26/2015 |
| Last Update Date | 03/07/2023 |
| Certification Date | 03/07/2023 |
| Medicare PECOS PAC ID | 3678887791 |
|---|---|
| Medicare Enrollment ID | O20150804003213 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497134332 | NPI | - | NPPES |
| Q3302 | Other | TX | MEDICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 2084P0805X | Psychiatry & Neurology - Geriatric Psychiatry | (* (Not Available)) | Secondary |
| Provider Name | Ramakrishna Veluri |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033525050 PECOS PAC ID: 4587978606 Enrollment ID: I20150804003432 |
| Provider Name | Ebelechukwu Ekwenugo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710535398 PECOS PAC ID: 3375979289 Enrollment ID: I20200212000506 |
| Provider Name | Nnene N Egbe-tambe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417541194 PECOS PAC ID: 6901298728 Enrollment ID: I20220127001858 |
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