| B. C. Muthappa, M.d., P.a. | |
|
120 Farm Road 2825 Clarksville TX 75426-3348 | |
| (903) 427-2201 | |
| Not Available |
| Full Name | B. C. Muthappa, M.d., P.a. |
|---|---|
| Speciality | Family Medicine |
| Location | 120 Farm Road 2825, Clarksville, Texas |
| Authorized Official Name and Position | Bacharanianda Chengappa Muthappa (PRESIDENT) |
| Authorized Official Contact | 9034272201 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| B. C. Muthappa, M.d., P.a. 120 Farm Road 2825 P O Box 1429 Clarksville TX 75426-3348 Ph: (903) 427-2201 | B. C. Muthappa, M.d., P.a. 120 Farm Road 2825 Clarksville TX 75426-3348 Ph: (903) 427-2201 |
| NPI Number | 1134205107 |
|---|---|
| Provider Enumeration Date | 10/31/2006 |
| Last Update Date | 10/06/2011 |
| Medicare PECOS PAC ID | 2961689500 |
|---|---|
| Medicare Enrollment ID | O20110607000558 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134205107 | NPI | - | NPPES |
| 1225203-04 | Medicaid | TX | |
| 000000BN34 | Other | TX | BCBS PROVIDER # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | F0268 (Texas) | Primary |
| 208600000X | Surgery | F0268 (Texas) | Secondary |
| Provider Name | Bacharanianda Muthappa |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1396835427 PECOS PAC ID: 3577740117 Enrollment ID: I20110607000594 |
| Provider Name | Deepak Bacharanianda Muthappa |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831532241 PECOS PAC ID: 5294020251 Enrollment ID: I20160830001053 |
| Provider Name | Chelsey Nicole Hinkle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710453733 PECOS PAC ID: 0446590814 Enrollment ID: I20190321000730 |
| Provider Name | Lauren Elise Peek Travillion |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639645658 PECOS PAC ID: 8729328117 Enrollment ID: I20190321001565 |
| Provider Name | Sarah Jeanette Morris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093364093 PECOS PAC ID: 0941633838 Enrollment ID: I20191206001661 |
| Provider Name | Stephanie Nicole Guzman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407476005 PECOS PAC ID: 0345639803 Enrollment ID: I20211123000635 |
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