1225034150 NPI number — DR. RAHUL PARIMOO M.D.

Table of content: DR. RAHUL PARIMOO M.D. (NPI 1225034150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225034150 NPI number — DR. RAHUL PARIMOO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARIMOO
Provider First Name:
RAHUL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225034150
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 708817
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84070-8817
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-869-2395
Provider Business Mailing Address Fax Number:
801-352-7976

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
414 NAVARRO ST
Provider Second Line Business Practice Location Address:
SUITE 1405
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78205-2516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-579-3036
Provider Business Practice Location Address Fax Number:
210-587-8167
Provider Enumeration Date:
06/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  M0212 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 01069679A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: ME128354 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 201024920 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000735865 . This is a "BCBS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 117839900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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