MEDICARE: LONE STAR INTERNAL MEDICINE ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	L0950	TX

General Provider Information

NPI Number	:	1417951393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONE STAR INTERNAL MEDICINE ASSOCIATES

Provider Business Mailing Address
First Line	:	617 CLARA BARTON BLVD
Second Line	:	STE 102
City	:	GARLAND
State	:	TX
Zip	:	75042-5761
Country	:	US
Telephone Number	:	972-485-4440
Fax Number	:	972-485-4443

Provider Business Practice Location Address
First Line	:	617 CLARA BARTON BLVD
Second Line	:	STE 102
City	:	GARLAND
State	:	TX
Zip	:	75042-5761
Country	:	US
Telephone Number	:	972-485-4440
Fax Number	:	972-485-4443

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ARCHANA THOTA
Credential	:	M.D
Telephone Number	:	972-485-4440

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	08/22/2020

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