| Lone Star Family Practice, Pa | |
|
9800 N Beach St Ste 508 Fort Worth TX 76244-6473 | |
| (817) 890-9111 | |
| (866) 939-1308 |
| Full Name | Lone Star Family Practice, Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 9800 N Beach St Ste 508, Fort Worth, Texas |
| Authorized Official Name and Position | Sudha R Jogimahanti (PRESIDENT) |
| Authorized Official Contact | 8172692964 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lone Star Family Practice, Pa Po Box 39 Roanoke TX 76262-0039 Ph: (817) 269-2964 | Lone Star Family Practice, Pa 9800 N Beach St Ste 508 Fort Worth TX 76244-6473 Ph: (817) 890-9111 |
| NPI Number | 1932703220 |
|---|---|
| Provider Enumeration Date | 11/26/2020 |
| Last Update Date | 11/15/2023 |
| Medicare PECOS PAC ID | 1456764737 |
|---|---|
| Medicare Enrollment ID | O20210105001829 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932703220 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Sudha R Jogimahanti |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649373614 PECOS PAC ID: 9739341405 Enrollment ID: I20120426000225 |
| Provider Name | Brenna A Young |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346828845 PECOS PAC ID: 4688073422 Enrollment ID: I20210526003359 |
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