1346240611 NPI number — PATRICK J SOMERVILLE MD

Table of content: PATRICK J SOMERVILLE MD (NPI 1346240611)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346240611 NPI number — PATRICK J SOMERVILLE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOMERVILLE
Provider First Name:
PATRICK
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1346240611
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5002 COWHORN CREEK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEXARKANA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75503-9766
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-614-3000
Provider Business Mailing Address Fax Number:
903-614-3525

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1902 MOORES LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEXARKANA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75503-4610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-792-7515
Provider Business Practice Location Address Fax Number:
903-614-3525
Provider Enumeration Date:
07/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  E2871 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208800000X , with the licence number: R2897 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100564701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107506001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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