Healthcare Provider Details

I. General information

NPI: 1992711329
Provider Name (Legal Business Name): AMARILLO COLON AND RECTAL CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 QUAIL CREEK DRIVE SUITE 103
AMARILLO TX
79124-1634
US

IV. Provider business mailing address

800 QUAIL CREEK DRIVE SUITE 103
AMARILLO TX
79124-1634
US

V. Phone/Fax

Practice location:
  • Phone: 806-358-7911
  • Fax: 806-358-9600
Mailing address:
  • Phone: 806-358-7911
  • Fax: 806-358-9600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: SAMBASIVA RAO MARUPUDI
Title or Position: PRESIDENT
Credential: MD
Phone: 806-358-7911