Provider Demographics
NPI:1528230810
Name:PATEL CLINIC LLC
Entity Type:Organization
Organization Name:PATEL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHYAYINI
Authorized Official - Middle Name:H
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-592-5918
Mailing Address - Street 1:530 W UNION ST
Mailing Address - Street 2:SUITEC
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-8303
Mailing Address - Country:US
Mailing Address - Phone:740-592-5918
Mailing Address - Fax:
Practice Address - Street 1:530 W UNION ST
Practice Address - Street 2:SUITEC
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-8303
Practice Address - Country:US
Practice Address - Phone:740-592-5918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH053955207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0676013Medicaid
OHA17036Medicare UPIN
OH0676013Medicaid