Provider Demographics
NPI:1235312901
Name:HARISH N. THAKKAR M.D.
Entity Type:Organization
Organization Name:HARISH N. THAKKAR M.D.
Other - Org Name:SOUTHWEST MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARISH
Authorized Official - Middle Name:N
Authorized Official - Last Name:THAKKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-903-7019
Mailing Address - Street 1:P.O. BOX 11124
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4002
Mailing Address - Country:US
Mailing Address - Phone:281-933-9304
Mailing Address - Fax:281-933-9305
Practice Address - Street 1:16959 SOUTHWEST FWY STE 200
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3481
Practice Address - Country:US
Practice Address - Phone:281-903-7019
Practice Address - Fax:832-886-4729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1096261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF78852Medicare UPIN
TX00620VMedicare PIN