Provider Demographics
NPI:1053363598
Name:BHARAT B LATTHE MD PA
Entity type:Organization
Organization Name:BHARAT B LATTHE MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BHARAT
Authorized Official - Middle Name:
Authorized Official - Last Name:LATTHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-709-2555
Mailing Address - Street 1:150 PINE FOREST DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-5302
Mailing Address - Country:US
Mailing Address - Phone:281-709-2555
Mailing Address - Fax:281-440-9915
Practice Address - Street 1:150 PINE FOREST DR
Practice Address - Street 2:SUITE 110
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-5302
Practice Address - Country:US
Practice Address - Phone:281-709-2555
Practice Address - Fax:281-440-9915
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY & SENIOR MEDICAL CLINIC PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-16
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6082207Q00000X, 207QG0300X
TX651038363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120662506Medicaid
TX187619502OtherTEXAS HEALTH STEPS
TX152611303Medicaid
P000614OtherMEDICARE RAILROAD
TX00064ETOtherBLUE CROSS
TX187619501Medicaid
TX152611303Medicaid
TX00064ETOtherBLUE CROSS
TX00W523Medicare PIN
P000614OtherMEDICARE RAILROAD
TX120662506Medicaid