=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558767723
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMRUTH S BAPATLA MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2014
-----------------------------------------------------
Last Update Date | 11/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6041 SW 73RD STREET RD
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34476-6464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-369-2040
-----------------------------------------------------
Fax | 352-369-2045
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1058
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34478-1058
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-369-2040
-----------------------------------------------------
Fax | 352-369-2045
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. MANORAMA BAPATLA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 352-854-6260
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------