Provider Demographics
NPI:1538928726
Name:SPIRIT CARE OF TEXAS PC
Entity type:Organization
Organization Name:SPIRIT CARE OF TEXAS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARVIND
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAKRAVARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-814-0963
Mailing Address - Street 1:3725 HAMILTON MILL RD
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-3909
Mailing Address - Country:US
Mailing Address - Phone:877-418-2466
Mailing Address - Fax:877-460-4201
Practice Address - Street 1:6504 NANCY ELLEN ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6327
Practice Address - Country:US
Practice Address - Phone:877-418-2466
Practice Address - Fax:877-460-4201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty