Provider Demographics
NPI:1487815593
Name:CHIYYARATH V SREENIVASAN M D
Entity Type:Organization
Organization Name:CHIYYARATH V SREENIVASAN M D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:
Authorized Official - First Name:CHIYYARATH
Authorized Official - Middle Name:V
Authorized Official - Last Name:SREENIVASAN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:806-355-8911
Mailing Address - Street 1:800 QUAIL CREEK DR STE 101
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-1634
Mailing Address - Country:US
Mailing Address - Phone:806-355-8911
Mailing Address - Fax:806-355-3182
Practice Address - Street 1:800 QUAIL CREEK DR STE 101
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-1634
Practice Address - Country:US
Practice Address - Phone:806-355-8911
Practice Address - Fax:806-355-3182
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHIYYARATH V SREENIVASAN M D
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-20
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6622282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z460Medicare PIN