Provider Demographics
NPI:1669841326
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:SUPERVISING PHYSICIAN
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 1:1120 MEDICAL PLAZA DR STE 240
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3212
Mailing Address - Country:US
Mailing Address - Phone:281-709-2555
Mailing Address - Fax:
Practice Address - Street 1:1120 MEDICAL PLAZA DR STE 240
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3212
Practice Address - Country:US
Practice Address - Phone:281-709-2555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129097261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX712311OtherTX RN LICENSE
TXAP129097OtherTX APRN LICENSE