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General NPI Number Information
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NPI Number | 1275953432
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Entity Type | Organization
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Legal Business Name | SSK PHYSICIAN ASSOCIATES
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Dates
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Enumeration Date | 04/25/2014
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Last Update Date | 02/10/2015
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Provider Practice Location Address
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Address Line | 409 GASLIGHT BLVD
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City | LUFKIN
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State | TX
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Zip | 75904-3132
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Country | US
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Telephone | 936-634-4422
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Fax | 936-634-4424
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Provider Business Mailing Address
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Address Line | 409 GASLIGHT BLVD
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City | LUFKIN
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State | TX
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Zip | 75904-3132
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Country | US
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Telephone | 936-634-4422
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Fax | 936-634-4424
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Authorized Official
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Title or Position | OWNER
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Name | SWATI S. KUMAR
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Credential | MD
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Telephone | 936-634-4422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | M9434
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License Number State | TX
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