1457527475 NPI number — PRAVINCHANDRA P. PATEL, MD P.C.

Table of content: (NPI 1457527475)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457527475 NPI number — PRAVINCHANDRA P. PATEL, MD P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRAVINCHANDRA P. PATEL, MD P.C.
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:
1457527475
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1060
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLDWATER
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38618-1060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-622-7011
Provider Business Mailing Address Fax Number:
662-622-0257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
423 CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLDWATER
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38618-3915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-622-7011
Provider Business Practice Location Address Fax Number:
662-622-0257
Provider Enumeration Date:
04/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
PRAVINCHANDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
DR.
Authorized Official Telephone Number:
662-622-7011

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MS 07838 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 09015376 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3963799 . This is a "CIGNA" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 0004324215 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00122592 . This is a "INDIVIDUAL MEDICAID" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 080183850 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 587274863D . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 1124098603 . This is a "MEDICARE INDIVIDUAL NPI" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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