Provider Demographics
NPI:1326295155
Name:FAMILY & SENIOR MEDICAL CLINIC,PA
Entity Type:Organization
Organization Name:FAMILY & SENIOR MEDICAL CLINIC,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BHARAT
Authorized Official - Middle Name:
Authorized Official - Last Name:LATTHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-709-2555
Mailing Address - Street 1:150 PINE FOREST DR
Mailing Address - Street 2:STE 110
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-5303
Mailing Address - Country:US
Mailing Address - Phone:281-709-2555
Mailing Address - Fax:281-440-9915
Practice Address - Street 1:150 PINE FOREST DR
Practice Address - Street 2:STE 110
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-5303
Practice Address - Country:US
Practice Address - Phone:281-709-2555
Practice Address - Fax:281-440-9915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-22
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty