Provider Demographics
NPI:1265186712
Name:ROSHEALTH PRIMARYCARE PC
Entity type:Organization
Organization Name:ROSHEALTH PRIMARYCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DURGA RAM PRASAD
Authorized Official - Middle Name:
Authorized Official - Last Name:TANNERU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-718-0155
Mailing Address - Street 1:2612 HARWOOD RD STE A
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-8308
Mailing Address - Country:US
Mailing Address - Phone:817-718-0155
Mailing Address - Fax:
Practice Address - Street 1:2612 HARWOOD RD STE A
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-8308
Practice Address - Country:US
Practice Address - Phone:817-718-0155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty