Provider Demographics
NPI:1679621023
Name:SENIOR HEALTH PHYSICIANS PA
Entity type:Organization
Organization Name:SENIOR HEALTH PHYSICIANS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SURUCHII
Authorized Official - Middle Name:
Authorized Official - Last Name:KATHPALIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-575-0228
Mailing Address - Street 1:PO BOX 3768
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77903-3768
Mailing Address - Country:US
Mailing Address - Phone:361-935-5135
Mailing Address - Fax:361-237-1585
Practice Address - Street 1:605 E SAN ANTONIO ST STE 310E
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6053
Practice Address - Country:US
Practice Address - Phone:361-575-0228
Practice Address - Fax:361-237-1585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5275207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184838401Medicaid
TXM5275OtherLICENSE
TX184838401Medicaid
TX00X204Medicare PIN