| Stavan Yogendra Patel, DDS, MD | |
|
2508 Bert Kouns Industrial Loop Ste 410, Shreveport, LA 71118-3157 | |
| (318) 212-5944 | |
| (318) 212-5949 |
| Full Name | Stavan Yogendra Patel |
|---|---|
| Gender | Male |
| Speciality | Maxillofacial Surgery |
| Experience | 16 Years |
| Location | 2508 Bert Kouns Industrial Loop Ste 410, Shreveport, Louisiana |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558688309 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 204E00000X | Oral & Maxillofacial Surgery | U0177 (Texas) | Secondary |
| 204E00000X | Oral & Maxillofacial Surgery | MD.302913 (Louisiana) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Christus Good Shepherd Medical Center | Longview, TX | Hospital |
| Willis Knighton Medical Center, Inc | Shreveport, LA | Hospital |
| Christus St Michael Health System | Texarkana, TX | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Wk Oral And Maxillofacial Surgery Institute | 6002203767 | 4 |
| Clhg-ruston Llc | 7315361425 | 24 |
| Christus Trinity Clinic Texas | 3072426741 | 1540 |
| Entity Name | Green Clinic LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1831178755 PECOS PAC ID: 4789668831 Enrollment ID: O20040616000177 |
| Entity Name | Minden Physician Practices LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1497986764 PECOS PAC ID: 4789720004 Enrollment ID: O20090930000103 |
| Entity Name | Shriners Hospitals for Children |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1679617849 PECOS PAC ID: 9133031933 Enrollment ID: O20121203000457 |
| Entity Name | LSU Health Sciences Center Shreveport Faculty Group Practice |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1013374222 PECOS PAC ID: 4082902721 Enrollment ID: O20161012000307 |
| Entity Name | WK Oral and Maxillofacial Surgery Institute |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1104584515 PECOS PAC ID: 6002203767 Enrollment ID: O20220427001091 |
| Entity Name | Clhg-ruston LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1154012185 PECOS PAC ID: 7315361425 Enrollment ID: O20220718002173 |
| Mailing Address | Practice Location Address |
|---|---|
| Stavan Yogendra Patel, DDS, MD 2508 Bert Kouns Industrial Loop Ste 410, Shreveport, LA 71118-3157 Ph: (318) 212-5944 | Stavan Yogendra Patel, DDS, MD 2508 Bert Kouns Industrial Loop Ste 410, Shreveport, LA 71118-3157 Ph: (318) 212-5944 |