| Clinicare Id Consultants Of Csra | |
|
1224 Augusta West Pkwy Augusta GA 30909-6582 | |
| (706) 922-0191 | |
| (706) 922-0192 |
| Full Name | Clinicare Id Consultants Of Csra |
|---|---|
| Speciality | Internal Medicine |
| Location | 1224 Augusta West Pkwy, Augusta, Georgia |
| Authorized Official Name and Position | Tarak V. Patel (OWNER/ MANAGING) |
| Authorized Official Contact | 7069220191 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clinicare Id Consultants Of Csra 1224 Augusta West Pkwy Augusta GA 30909-6582 Ph: (706) 922-0191 | Clinicare Id Consultants Of Csra 1224 Augusta West Pkwy Augusta GA 30909-6582 Ph: (706) 922-0191 |
| NPI Number | 1366876922 |
|---|---|
| Provider Enumeration Date | 08/30/2013 |
| Last Update Date | 09/08/2013 |
| Medicare PECOS PAC ID | 0648405787 |
|---|---|
| Medicare Enrollment ID | O20131028000943 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366876922 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | 066394 (Georgia) | Primary |
| Provider Name | Tarak V Patel |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1578751871 PECOS PAC ID: 6204915358 Enrollment ID: I20111129000268 |
| Provider Name | Jason Stephens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598137481 PECOS PAC ID: 1850698366 Enrollment ID: I20160329001242 |
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