1417172933 NPI number — HARSHAD G SHAH MD PA EYE INSTITUTE

Table of content: (NPI 1417172933)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417172933 NPI number — HARSHAD G SHAH MD PA EYE INSTITUTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARSHAD G SHAH MD PA EYE INSTITUTE
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:
1417172933
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4214 ANDREWS HWY STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79703-4813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
432-686-2020
Provider Business Mailing Address Fax Number:
432-570-0888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4214 ANDREWS HWY STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79703-4813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-686-2020
Provider Business Practice Location Address Fax Number:
432-570-0888
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHAH
Authorized Official First Name:
HARSHAD
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
432-686-2020

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  G7461 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 083174501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: DB8827 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: V3363 . This is a "NEW MEXICO PROVIDER NUMBE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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