| Yn Pakkala M.d, P.c | |
|
630 Nuckolls Rd Bolivar TN 38008-1532 | |
| (731) 658-6011 | |
| (731) 658-9884 |
| Full Name | Yn Pakkala M.d, P.c |
|---|---|
| Speciality | General Practice |
| Location | 630 Nuckolls Rd, Bolivar, Tennessee |
| Authorized Official Name and Position | Nithyananda Pakkala (DOCTOR) |
| Authorized Official Contact | 7316586011 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Yn Pakkala M.d, P.c 630 Nuckolls Rd Bolivar TN 38008-1532 Ph: (731) 658-6011 | Yn Pakkala M.d, P.c 630 Nuckolls Rd Bolivar TN 38008-1532 Ph: (731) 658-6011 |
| NPI Number | 1841555141 |
|---|---|
| Provider Enumeration Date | 07/12/2012 |
| Last Update Date | 09/09/2013 |
| Medicare PECOS PAC ID | 6002057486 |
|---|---|
| Medicare Enrollment ID | O20130726000733 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841555141 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | MD9916 (Tennessee) | Primary |
| Provider Name | Nithyananda Pakkala |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578558607 PECOS PAC ID: 3274774658 Enrollment ID: I20130726000746 |
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Hardeman County Community Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 629 Nuckolls Rd, Bolivar, TN 38008 Phone: 731-658-3388 Fax: 731-659-3131 | |
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