Provider Demographics
NPI:1679613525
Name:PRAVIN R PATEL MD.
Entity Type:Organization
Organization Name:PRAVIN R PATEL MD.
Other - Org Name:CLIO MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:PRAVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-586-2292
Mailing Address - Street 1:200 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:SC
Mailing Address - Zip Code:29525
Mailing Address - Country:US
Mailing Address - Phone:843-586-2292
Mailing Address - Fax:
Practice Address - Street 1:200 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:SC
Practice Address - Zip Code:29525
Practice Address - Country:US
Practice Address - Phone:843-586-2292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC113139207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3103Medicaid
SCGP3103Medicaid
SCD750770282Medicare PIN