MEDICARE: SUVIPA WIRI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	G2058	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5327012	OTHER		AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1415750	OTHER		FIRSTHEALTH CCN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	114352	OTHER	TX	SUPERIOR HEALTH PLAN
7	127136101	OTHER	TX	FIRSTCARE
8	00TF58	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1952399818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUVIPA WIRI MD

Provider Business Mailing Address
First Line	:	1000 FM 300
Second Line	:
City	:	LEVELLAND
State	:	TX
Zip	:	79336-6235
Country	:	US
Telephone Number	:	806-894-7842
Fax Number	:	806-894-3378

Provider Business Practice Location Address
First Line	:	1000 FM 300
Second Line	:
City	:	LEVELLAND
State	:	TX
Zip	:	79336-6235
Country	:	US
Telephone Number	:	806-894-7842
Fax Number	:	806-894-3952

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	02/28/2014

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Directions to “ SUVIPA WIRI MD” Practice Location

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