Provider Demographics
NPI:1932703220
Name:LONE STAR FAMILY PRACTICE, PA
Entity Type:Organization
Organization Name:LONE STAR FAMILY PRACTICE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUDHA
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOGIMAHANTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-269-2964
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:TX
Mailing Address - Zip Code:76262-0039
Mailing Address - Country:US
Mailing Address - Phone:817-269-2964
Mailing Address - Fax:
Practice Address - Street 1:9800 N BEACH ST STE 508
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6473
Practice Address - Country:US
Practice Address - Phone:817-890-9111
Practice Address - Fax:866-939-1308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-26
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty