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Organization
RAVI PACHIGOLLA MD PSC
Active
Organization
RAVI PACHIGOLLA MD PSC
Active
Other names
Ravi Pachigolla MD PSC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAVI V 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
207Y00000X
Otolaryngology Physician
Primary
K4763
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00Z738
MEDICARE GROUP PIN
TX
01
—
1295932549
GROUP NPI #
—
01
—
198437901
MEDICAID GRP PIN#
TX
05
—
198438701
—
TX
01
—
38283
LICENSE NUMBER
KY
05
—
64071855
—
KY
01
—
K4763
TEXAS LICENSE
TX
Enumeration date
06/29/2007
Last updated
04/28/2022
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