1003091000 NPI number — SRINIVAS PATHAPATI, MDPA

Table of content: (NPI 1003091000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003091000 NPI number — SRINIVAS PATHAPATI, MDPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SRINIVAS PATHAPATI, MDPA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003091000
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9467
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915-9467
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-467-9820
Provider Business Mailing Address Fax Number:
806-467-9743

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6833 PLUM CREEK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79124-1602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-467-9820
Provider Business Practice Location Address Fax Number:
806-467-9743
Provider Enumeration Date:
01/08/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PATHAPATI
Authorized Official First Name:
SRINIVAS
Authorized Official Middle Name:
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
806-467-9820

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: G57397 . This is a "UPIN NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: K9386 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0066QV . This is a "BCBS NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: DF5955 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 160273201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: USE EIN . This is a "CHAMPUS/TRICARE PGBA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".