Provider Demographics
NPI:1255645131
Name:PRAVINCHA P. PATEL, M.D.
Entity type:Organization
Organization Name:PRAVINCHA P. PATEL, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAVINCHA
Authorized Official - Middle Name:P
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-622-7011
Mailing Address - Street 1:291 DOC WOODY RD
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MS
Mailing Address - Zip Code:38618-3501
Mailing Address - Country:US
Mailing Address - Phone:662-562-7092
Mailing Address - Fax:
Practice Address - Street 1:423 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MS
Practice Address - Zip Code:38618-3915
Practice Address - Country:US
Practice Address - Phone:662-622-7011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR868252261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care