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Organization
RUPA PACHIGOLLA MD PSC
Active
Organization
RUPA PACHIGOLLA MD PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUPA PACHIGOLLA M.D. (PHYSICIAN)
(817) 596-8637
Entity
Organization
Contact information
Practice address
2016 FORT WORTH HWY, WEATHERFORD, TX 76086-4706
(817) 596-8637
(817) 599-3614
Mailing address
2016 FORT WORTH HWY, WEATHERFORD, TX 76086-4706
(817) 596-8637
(817) 599-3614
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
N0337
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00Z738
MEDICARE GROUP PIN
TX
05
—
1003013350
—
TX
01
—
1639165731
MCRE INDV NPI #
—
01
—
197259801
MEDICAID GRP #
TX
05
—
197261401
—
TX
01
—
38179
LICENSE NUMBER
KY
01
—
45D1093868
CLIA #
TX
05
—
64071715
—
KY
01
—
N0337
TEXAS LICENSE
TX
Enumeration date
06/29/2007
Last updated
04/28/2022
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