Provider Demographics
NPI:1952376758
Name:SREENIVASAN, C
Entity Type:Individual
Prefix:
First Name:C
Middle Name:
Last Name:SREENIVASAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 QUAIL CREEK DR
Mailing Address - Street 2:STE 101
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-1634
Mailing Address - Country:US
Mailing Address - Phone:806-355-8911
Mailing Address - Fax:806-355-3182
Practice Address - Street 1:800 QUAIL CREEK DR
Practice Address - Street 2:STE 101
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-1634
Practice Address - Country:US
Practice Address - Phone:806-355-8911
Practice Address - Fax:806-355-3182
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6622207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114741503Medicaid
C22144Medicare UPIN
8F8567Medicare PIN