Provider Demographics
NPI:1992711329
Name:AMARILLO COLON AND RECTAL CLINIC PA
Entity type:Organization
Organization Name:AMARILLO COLON AND RECTAL CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMBASIVA
Authorized Official - Middle Name:RAO
Authorized Official - Last Name:MARUPUDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-358-7911
Mailing Address - Street 1:800 QUAIL CREEK DRIVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-1634
Mailing Address - Country:US
Mailing Address - Phone:806-358-7911
Mailing Address - Fax:806-358-9600
Practice Address - Street 1:800 QUAIL CREEK DRIVE
Practice Address - Street 2:SUITE 103
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-1634
Practice Address - Country:US
Practice Address - Phone:806-358-7911
Practice Address - Fax:806-358-9600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DB7392OtherRAILROAD MEDICARE
7330374OtherAETNA INS CO
TX007KZOtherBLUE CROSS BLUE SHIELD
DB7392OtherRAILROAD MEDICARE