Provider Demographics
NPI:1457472110
Name:SITA M DEVULAPALLI, MD, PA
Entity Type:Organization
Organization Name:SITA M DEVULAPALLI, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SITA
Authorized Official - Middle Name:MAHALAKSHMI
Authorized Official - Last Name:DEVULAPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-234-9500
Mailing Address - Street 1:903 WALNUT HILL DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5062
Mailing Address - Country:US
Mailing Address - Phone:903-234-9500
Mailing Address - Fax:903-234-2360
Practice Address - Street 1:903 WALNUT HILL DR
Practice Address - Street 2:SUITE 1
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5062
Practice Address - Country:US
Practice Address - Phone:903-234-9500
Practice Address - Fax:903-234-2360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4038261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029636001Medicaid
TX0012CAOtherBCBSTX