Provider Demographics
NPI:1952399818
Name:WIRI, SUVIPA (MD)
Entity Type:Individual
Prefix:
First Name:SUVIPA
Middle Name:
Last Name:WIRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 FM 300
Mailing Address - Street 2:
Mailing Address - City:LEVELLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79336-6235
Mailing Address - Country:US
Mailing Address - Phone:806-894-7842
Mailing Address - Fax:806-894-3378
Practice Address - Street 1:1000 FM 300
Practice Address - Street 2:
Practice Address - City:LEVELLAND
Practice Address - State:TX
Practice Address - Zip Code:79336-6235
Practice Address - Country:US
Practice Address - Phone:806-894-7842
Practice Address - Fax:806-894-3952
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2058208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
5327012OtherAETNA
TX126277602Medicaid
TX121513902Medicaid
1415750OtherFIRSTHEALTH CCN
TX126277606Medicaid
TX114352OtherSUPERIOR HEALTH PLAN
TX127136101OtherFIRSTCARE
TX00TF58OtherBLUE CROSS BLUE SHIELD
1415750OtherFIRSTHEALTH CCN
TX114352OtherSUPERIOR HEALTH PLAN