| Sita M Devulapalli, Md, Pa | |
|
903 Walnut Hill Dr Suite 1 Longview TX 75605-5062 | |
| (903) 234-9500 | |
| (903) 234-2360 |
| Full Name | Sita M Devulapalli, Md, Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 903 Walnut Hill Dr, Longview, Texas |
| Authorized Official Name and Position | Sita Mahalakshmi Devulapalli (PRESIDENT) |
| Authorized Official Contact | 9032349500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sita M Devulapalli, Md, Pa 903 Walnut Hill Dr Suite 1 Longview TX 75605-5062 Ph: (903) 234-9500 | Sita M Devulapalli, Md, Pa 903 Walnut Hill Dr Suite 1 Longview TX 75605-5062 Ph: (903) 234-9500 |
| NPI Number | 1457472110 |
|---|---|
| Provider Enumeration Date | 04/02/2007 |
| Last Update Date | 07/26/2011 |
| Medicare PECOS PAC ID | 3971790080 |
|---|---|
| Medicare Enrollment ID | O20101214001261 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457472110 | NPI | - | NPPES |
| 029636001 | Medicaid | TX | |
| 0012CA | Other | TX | BCBSTX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | K4038 (Texas) | Primary |
| Provider Name | Sita Devulapalli |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578558904 PECOS PAC ID: 4688861792 Enrollment ID: I20101214001282 |
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