Individual ProviderSimhachalam GurugubelliInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address11109 Parkview Plaza Dr, Fort Wayne, IN 46845-1701(260) 672-6620PECOS EnrollmentBased on the most recent information from CMS, provider Simhachalam Gurugubelli is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1891281820Provider TypeIndividualFull NameGurugubelli, SimhachalamCredentialMDGenderMaleSole ProprietorNoEnumeration Date7/2/2018Last Updated9/3/2024Contact InformationPractice LocationPractice Address11109 Parkview Plaza Dr, Fort Wayne, IN 46845-1701Phone(260) 672-6620Fax(260) 672-6639Mailing LocationMailing Address11109 Parkview Plaza Dr # 117, Fort Wayne, IN 46845-1701PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense01092805AIndianaCode207R00000XDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense29092MississippiCode207R00000XDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense4301116161MichiganCode208M00000XDescriptionHospitalistAllopathic & Osteopathic PhysiciansLicense29092Mississippi