Provider Demographics
NPI:1689455685
Name:FORT WORTH INSTITUTE OF MEDICAL SCIENCES LLC
Entity Type:Organization
Organization Name:FORT WORTH INSTITUTE OF MEDICAL SCIENCES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:SIRIPURAPU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-544-6600
Mailing Address - Street 1:PO BOX 271600
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75027-1600
Mailing Address - Country:US
Mailing Address - Phone:972-544-6600
Mailing Address - Fax:
Practice Address - Street 1:1023 LIPSCOMB ST STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3102
Practice Address - Country:US
Practice Address - Phone:972-544-6600
Practice Address - Fax:972-544-6604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty