Provider Demographics
NPI:1023146594
Name:ASSOCIATES OF INTERNAL MEDICINE
Entity type:Organization
Organization Name:ASSOCIATES OF INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAVANI
Authorized Official - Middle Name:
Authorized Official - Last Name:BELLARY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:682-268-1152
Mailing Address - Street 1:PO BOX 12056
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-8056
Mailing Address - Country:US
Mailing Address - Phone:682-268-1152
Mailing Address - Fax:817-818-1766
Practice Address - Street 1:2260 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-1952
Practice Address - Country:US
Practice Address - Phone:682-268-1152
Practice Address - Fax:877-772-0063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8281207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1765463Medicaid
TX00684XMedicare ID - Type UnspecifiedGROUP MEDICARE NUMBER