Provider Demographics
NPI:1144438532
Name:SURYCHANDRA S PATEL
Entity type:Organization
Organization Name:SURYCHANDRA S PATEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SURYACHANDRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-547-7161
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40146-0147
Mailing Address - Country:US
Mailing Address - Phone:270-547-7161
Mailing Address - Fax:270-547-7163
Practice Address - Street 1:205 W. US 60
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:KY
Practice Address - Zip Code:40146
Practice Address - Country:US
Practice Address - Phone:270-547-7161
Practice Address - Fax:270-547-7163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20984207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000058825OtherANTHEM
KY50006015OtherPASSPORT
KYDA0854OtherRAILROAD MEDICARE
KY2447302001OtherPASSPORT ADVANTAGE
KY6432Medicare ID - Type Unspecified
KY50006015OtherPASSPORT