1588761852 NPI number — BHARATBHAI G PATEL

Table of content: (NPI 1588761852)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588761852 NPI number — BHARATBHAI G PATEL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BHARATBHAI G PATEL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1588761852
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4127
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24015-0127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-981-9394
Provider Business Mailing Address Fax Number:
540-344-7154

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5712 LONGRIDGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROANOKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24018-7888
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-725-5876
Provider Business Practice Location Address Fax Number:
540-725-5876
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
BHARATBHAI
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
540-725-5876

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110206915 . This is a "MEDICARE RR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110007565 . This is a "MEDICARE LEGACY NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 119503 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 005836158 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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