Provider Demographics
NPI:1760667356
Name:C G PATEL MD PA
Entity Type:Organization
Organization Name:C G PATEL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HINA
Authorized Official - Middle Name:C
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-722-3175
Mailing Address - Street 1:1411 S HIGHWAY 69
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-7842
Mailing Address - Country:US
Mailing Address - Phone:409-722-3175
Mailing Address - Fax:409-727-7987
Practice Address - Street 1:1411 S HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-7842
Practice Address - Country:US
Practice Address - Phone:409-722-3175
Practice Address - Fax:409-727-7987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3872174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AU520OtherBLUE CROSS BLUE SHIELD OF TX
TX115272001Medicaid
TX1134154545Medicaid
TX0042QUOtherBLUE CROSS BLUE SHIELD OF TX
TX8AU520OtherBLUE CROSS BLUE SHIELD OF TX
TX115272001Medicaid
TX00Y963Medicare PIN