Provider Demographics
NPI:1952632739
Name:SHROFF CARDIOLOGY & INTERNAL MEDICINE CLINIC PA
Entity Type:Organization
Organization Name:SHROFF CARDIOLOGY & INTERNAL MEDICINE CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MANISH
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHROFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-267-9805
Mailing Address - Street 1:PO BOX 150
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79721-0150
Mailing Address - Country:US
Mailing Address - Phone:432-267-9805
Mailing Address - Fax:432-264-7542
Practice Address - Street 1:1501 W 11TH PL STE 301
Practice Address - Street 2:#301
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-4121
Practice Address - Country:US
Practice Address - Phone:432-267-9805
Practice Address - Fax:432-264-7542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-19
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5063207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216395801Medicaid
TXTXB108198Medicare PIN