=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902190564
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEWBORN HEARING SCREENS OF WEST TEXAS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2011
-----------------------------------------------------
Last Update Date | 06/01/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2200 W ILLINOIS AVE
-----------------------------------------------------
City | MIDLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79701-6407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 432-563-0277
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 SANTA ELENA CT
-----------------------------------------------------
City | ODESSA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79765-8503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SANJAY P PATEL
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 432-563-0277
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | L8160
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------