Basic Information
| Provider Information | |||||||||
| NPI: | 1417961327 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAVIPATI | ||||||||
| FirstName: | ANITA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 840048 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752840048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8062125079 | ||||||||
| FaxNumber: | 8062126278 | ||||||||
| Practice Location | |||||||||
| Address1: | 1751 WALLACE BLVD | ||||||||
| Address2: | |||||||||
| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791061711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8062124673 | ||||||||
| FaxNumber: | 8062120057 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 12/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301081421 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0003X | N5963 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 269056YNR6 | 01 | TX | MEDICARE | OTHER | 281630802 | 05 | TX | MEDICAID |