1659354843 NPI number — DR. RAJAN I MEHTA M.D.

Table of content: DR. RAJAN I MEHTA M.D. (NPI 1659354843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659354843 NPI number — DR. RAJAN I MEHTA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEHTA
Provider First Name:
RAJAN
Provider Middle Name:
I
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:
1659354843
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
737 E CRAWFORD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALINA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67401-5103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-822-0202
Provider Business Mailing Address Fax Number:
785-827-6334

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
737 E CRAWFORD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALINA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67401-5103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-827-7261
Provider Business Practice Location Address Fax Number:
785-833-5709
Provider Enumeration Date:
11/22/2005

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: 207K00000X , with the licence number:  01038376 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000088459 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 351830931100 . This is a "CARESOURCE PIN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 100184670A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110051751 . This is a "RAILROAD MCR PIN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 280784 . This is a "HARMONY PIN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 351830931 . This is a "TAX ID" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com