Provider Demographics
NPI:1790276384
Name:SP RHEUMATOLOGY PLLC
Entity Type:Organization
Organization Name:SP RHEUMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SANTHI
Authorized Official - Middle Name:
Authorized Official - Last Name:PENMETSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-972-4443
Mailing Address - Street 1:211 E AVENUE G #1358
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-3039
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:423 E MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-3345
Practice Address - Country:US
Practice Address - Phone:972-972-4443
Practice Address - Fax:972-972-4470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-20
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9634207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty