Provider Demographics
NPI:1528383577
Name:PATEL MEDICAL CLINIC PA
Entity Type:Organization
Organization Name:PATEL MEDICAL CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHILPESH
Authorized Official - Middle Name:SHANTILAL
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-835-6500
Mailing Address - Street 1:PO BOX 1089
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29716-1089
Mailing Address - Country:US
Mailing Address - Phone:803-835-6500
Mailing Address - Fax:803-835-1990
Practice Address - Street 1:515 RIVER CROSSING DR
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-7900
Practice Address - Country:US
Practice Address - Phone:803-835-6500
Practice Address - Fax:803-835-1990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20083207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC200838Medicaid
SCF67746Medicare UPIN