Provider Demographics
NPI:1417951393
Name:LONE STAR INTERNAL MEDICINE ASSOCIATES
Entity Type:Organization
Organization Name:LONE STAR INTERNAL MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARCHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-485-4440
Mailing Address - Street 1:617 CLARA BARTON BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-5761
Mailing Address - Country:US
Mailing Address - Phone:972-485-4440
Mailing Address - Fax:972-485-4443
Practice Address - Street 1:617 CLARA BARTON BLVD
Practice Address - Street 2:STE 102
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5761
Practice Address - Country:US
Practice Address - Phone:972-485-4440
Practice Address - Fax:972-485-4443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0950207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH29559Medicare UPIN
TX8645B8Medicare ID - Type Unspecified