MEDICARE: PORTER MEDICAL CENTER PLLC

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	207Q00000X	Family Medicine Physician	L2481	TX

General Provider Information

NPI Number	:	1134546864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PORTER MEDICAL CENTER PLLC

Provider Business Mailing Address
First Line	:	24540 FM 1314 RD
Second Line	:
City	:	PORTER
State	:	TX
Zip	:	77365-4204
Country	:	US
Telephone Number	:	832-326-8032
Fax Number	:	281-354-8815

Provider Business Practice Location Address
First Line	:	24540 FM 1314 RD
Second Line	:
City	:	PORTER
State	:	TX
Zip	:	77365-4204
Country	:	US
Telephone Number	:	832-326-8032
Fax Number	:	281-354-8815

Authorized Official
Title or Position	:	OWN
Name	:	DR. RAVI MOPARTY
Credential	:	M.D.
Telephone Number	:	832-722-8283

Provider Enumeration Date	:	03/19/2014
Last Update Date	:	03/19/2014

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