Healthcare Provider Details

I. General information

NPI: 1720630825
Provider Name (Legal Business Name): YALAMANCHILI PHYSICIANS GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 PRESTWICK LN
AMARILLO TX
79124-4975
US

IV. Provider business mailing address

62 PRESTWICK LN
AMARILLO TX
79124-4975
US

V. Phone/Fax

Practice location:
  • Phone: 806-355-6593
  • Fax: 806-352-8774
Mailing address:
  • Phone: 806-420-7222
  • Fax: 806-352-8774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KISHAN YALAMANCHILI
Title or Position: PRESIDENT
Credential: MD
Phone: 806-420-7222