| Rupa Pachigolla Md Psc | |
|
2016 Fort Worth Hwy Weatherford TX 76086-4706 | |
| (817) 596-8637 | |
| (817) 599-3614 |
| Full Name | Rupa Pachigolla Md Psc |
|---|---|
| Speciality | Family Medicine |
| Location | 2016 Fort Worth Hwy, Weatherford, Texas |
| Authorized Official Name and Position | Rupa Pachigolla (PHYSICIAN) |
| Authorized Official Contact | 8175968637 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rupa Pachigolla Md Psc 2016 Fort Worth Hwy Weatherford TX 76086-4706 Ph: (817) 596-8637 | Rupa Pachigolla Md Psc 2016 Fort Worth Hwy Weatherford TX 76086-4706 Ph: (817) 596-8637 |
| NPI Number | 1003013350 |
|---|---|
| Provider Enumeration Date | 06/29/2007 |
| Last Update Date | 04/28/2022 |
| Medicare PECOS PAC ID | 9335042472 |
|---|---|
| Medicare Enrollment ID | O20081121000216 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003013350 | NPI | - | NPPES |
| 00Z738 | Other | TX | MEDICARE GROUP PIN |
| 197261401 | Medicaid | TX | |
| 45D1093868 | Other | TX | CLIA # |
| 1639165731 | Other | MCRE INDV NPI # | |
| 38179 | Other | KY | LICENSE NUMBER |
| 1003013350 | Medicaid | TX | |
| N0337 | Other | TX | TEXAS LICENSE |
| 197259801 | Other | TX | MEDICAID GRP # |
| 64071715 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | N0337 (Texas) | Primary |
| Provider Name | Rupa Pachigolla |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639165731 PECOS PAC ID: 9133022288 Enrollment ID: I20081126000045 |
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