Provider Demographics
NPI:1457527475
Name:PRAVINCHANDRA P. PATEL, MD P.C.
Entity type:Organization
Organization Name:PRAVINCHANDRA P. PATEL, MD P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAVINCHANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-622-7011
Mailing Address - Street 1:PO BOX 1060
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MS
Mailing Address - Zip Code:38618-1060
Mailing Address - Country:US
Mailing Address - Phone:662-622-7011
Mailing Address - Fax:662-622-0257
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:662-622-0257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS 07838207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015376Medicaid
MS3963799OtherCIGNA
0004324215OtherAETNA
MS00122592OtherINDIVIDUAL MEDICAID
MS080183850OtherRAILROAD MEDICARE
MS587274863DOtherBLUE CROSS BLUE SHIELD
MS1124098603OtherMEDICARE INDIVIDUAL NPI
MS1124098603OtherMEDICARE INDIVIDUAL NPI
MS09015376Medicaid