Provider Demographics
NPI:1891985271
Name:SHAMROCK PSYCHIATRIC CLINIC P A
Entity Type:Organization
Organization Name:SHAMROCK PSYCHIATRIC CLINIC P A
Other - Org Name:SHAMROCK PSYCHIATRIC CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GURUSWAMI
Authorized Official - Middle Name:K
Authorized Official - Last Name:RAVICHANDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-988-9911
Mailing Address - Street 1:6420 HILLCROFT ST
Mailing Address - Street 2:411
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-3190
Mailing Address - Country:US
Mailing Address - Phone:713-988-9911
Mailing Address - Fax:713-995-4205
Practice Address - Street 1:6420 HILLCROFT ST
Practice Address - Street 2:411
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-3190
Practice Address - Country:US
Practice Address - Phone:713-988-9911
Practice Address - Fax:713-995-4205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF35882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX082622401Medicaid
TX00FX78Medicare PIN