MEDICARE: RUPA R PACHIGOLLA M.D.

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	N0337	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	00Z863	OTHER	TX	MEDICARE GRP PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	N0337	OTHER	TX	TEXAS LICENSE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639165731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUPA R PACHIGOLLA M.D.

Provider Business Mailing Address
First Line	:	2016 FORT WORTH HWY
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-4706
Country	:	US
Telephone Number	:	817-596-8637
Fax Number	:	817-599-3614

Provider Business Practice Location Address
First Line	:	2016 FORT WORTH HWY
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76086-4706
Country	:	US
Telephone Number	:	817-596-8637
Fax Number	:	817-599-3614

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	04/28/2022

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Directions to “ RUPA R PACHIGOLLA M.D.” Practice Location

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