Provider Demographics
NPI:1184653008
Name:SUGAR LAND GERIATRICS & MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:SUGAR LAND GERIATRICS & MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SONAL
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-491-3225
Mailing Address - Street 1:3531 TOWN CENTER BLVD S STE 101
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2591
Mailing Address - Country:US
Mailing Address - Phone:281-491-3225
Mailing Address - Fax:281-491-1702
Practice Address - Street 1:3531 TOWN CENTER BLVD S STE 101
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2591
Practice Address - Country:US
Practice Address - Phone:281-491-3225
Practice Address - Fax:281-491-1702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00412YOtherMEDICARE GROUP NUMBER
TX172579801Medicaid