| Boppana Primary Care Clinic, Pllc | |
|
2460 N Central Expy Suite 101 Richardson TX 75080-2713 | |
| (972) 644-1100 | |
| (972) 644-1107 |
| Full Name | Boppana Primary Care Clinic, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2460 N Central Expy, Richardson, Texas |
| Authorized Official Name and Position | Sita M Boppana (PRESIDENT) |
| Authorized Official Contact | 9726441100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Boppana Primary Care Clinic, Pllc Po Box 830066 Richardson TX 75083-0066 Ph: (972) 644-1100 | Boppana Primary Care Clinic, Pllc 2460 N Central Expy Suite 101 Richardson TX 75080-2713 Ph: (972) 644-1100 |
| NPI Number | 1326168139 |
|---|---|
| Provider Enumeration Date | 03/29/2007 |
| Last Update Date | 11/05/2018 |
| Medicare PECOS PAC ID | 1759307663 |
|---|---|
| Medicare Enrollment ID | O20051020000313 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326168139 | NPI | - | NPPES |
| 151198201 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Sita M Boppana |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1689629123 PECOS PAC ID: 3476564402 Enrollment ID: I20091205000130 |
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