MEDICARE: SOUTHWEST INTERNAL MEDICINE PA

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	MO229	TX

General Provider Information

NPI Number	:	1114255106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST INTERNAL MEDICINE PA

Provider Business Mailing Address
First Line	:	5317 QUAIL FEATHER DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-2956
Country	:	US
Telephone Number	:	817-800-3196
Fax Number	:

Provider Business Practice Location Address
First Line	:	5317 QUAIL FEATHER DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-2956
Country	:	US
Telephone Number	:	817-800-3196
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. RAMU RANGINENI
Credential	:	M.D
Telephone Number	:	817-386-9818

Provider Enumeration Date	:	12/02/2009
Last Update Date	:	12/02/2009

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