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General NPI Number Information
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NPI Number | 1083643852
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Entity Type | Organization
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Legal Business Name | AMARILLO COLONOSCOPY CENTER LP
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 01/22/2014
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Provider Practice Location Address
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Address Line | 800 QUAIL CREEK DRIVE SUITE 102
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City | AMARILLO
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State | TX
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Zip | 79124-1634
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Country | US
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Telephone | 806-367-8537
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Fax | 806-367-8538
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Provider Business Mailing Address
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Address Line | 800 QUAIL CREEK DRIVE SUITE 102
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City | AMARILLO
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State | TX
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Zip | 79124-1634
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Country | US
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Telephone | 806-367-8537
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Fax | 806-367-8538
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DR. SAMBASIVA RAO MARUPUDI
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Credential | M.D.
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Telephone | 806-367-8537
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 008144
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License Number State | TX
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