Basic Information
| Provider Information | |||||||||
| NPI: | 1952399818 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WIRI | ||||||||
| FirstName: | SUVIPA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 FM 300 | ||||||||
| Address2: | |||||||||
| City: | LEVELLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 793366235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8068947842 | ||||||||
| FaxNumber: | 8068943378 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 FM 300 | ||||||||
| Address2: | |||||||||
| City: | LEVELLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 793366235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8068947842 | ||||||||
| FaxNumber: | 8068943952 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2005 | ||||||||
| LastUpdateDate: | 02/28/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | G2058 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 5327012 | 01 | AETNA | OTHER | 126277602 | 05 | TX | MEDICAID | 121513902 | 05 | TX | MEDICAID | 1415750 | 01 | FIRSTHEALTH CCN | OTHER | 126277606 | 05 | TX | MEDICAID | 114352 | 01 | TX | SUPERIOR HEALTH PLAN | OTHER | 127136101 | 01 | TX | FIRSTCARE | OTHER | 00TF58 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER |