Provider Demographics
NPI:1558767723
Name:AMRUTH S BAPATLA MD PA
Entity Type:Organization
Organization Name:AMRUTH S BAPATLA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MANORAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAPATLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-854-6260
Mailing Address - Street 1:PO BOX 1058
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-1058
Mailing Address - Country:US
Mailing Address - Phone:352-369-2040
Mailing Address - Fax:352-369-2045
Practice Address - Street 1:6041 SW 73RD STREET RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-6464
Practice Address - Country:US
Practice Address - Phone:352-369-2040
Practice Address - Fax:352-369-2045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID
FL27838AMedicare PIN