Provider Demographics
NPI:1114244860
Name:YALAMANCHILI, BINDU BHARGAVI (MBBS)
Entity Type:Individual
Prefix:
First Name:BINDU
Middle Name:BHARGAVI
Last Name:YALAMANCHILI
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:BINDU
Other - Middle Name:BHARGAVI
Other - Last Name:NAGUBOYINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 840026
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0026
Mailing Address - Country:US
Mailing Address - Phone:806-212-6965
Mailing Address - Fax:806-212-6278
Practice Address - Street 1:1600 WALLACE BLVD
Practice Address - Street 2:BSA HOSPITALIST GROUP
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1786
Practice Address - Country:US
Practice Address - Phone:806-212-2129
Practice Address - Fax:806-212-6278
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP6751207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX325891501Medicaid
TX325891501Medicaid