Provider Demographics
NPI:1134365802
Name:VISHNU K RUMALLA, M.D.
Entity type:Organization
Organization Name:VISHNU K RUMALLA, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VISHNU
Authorized Official - Middle Name:
Authorized Official - Last Name:RUMALLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-334-0030
Mailing Address - Street 1:800 EIGHTH AVE
Mailing Address - Street 2:SUITE #240
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2619
Mailing Address - Country:US
Mailing Address - Phone:817-334-0030
Mailing Address - Fax:
Practice Address - Street 1:800 EIGHTH AVE
Practice Address - Street 2:SUITE #240
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2619
Practice Address - Country:US
Practice Address - Phone:817-334-0030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00999WMedicare PIN