1104449206 NPI number — KRUTI GITESH SHAH MBBS

Table of content: KRUTI GITESH SHAH MBBS (NPI 1104449206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104449206 NPI number — KRUTI GITESH SHAH MBBS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAH
Provider First Name:
KRUTI
Provider Middle Name:
GITESH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MBBS
Provider Gender Code:
F

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:
1104449206
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/18/2022
NPI Reactivation Date:
02/11/2022

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MOUNTAIN VIEW REGIONAL MEDICAL CENTE
Provider Second Line Business Mailing Address:
4351 E LOHMAN AVENUE BUILDING 3, SUITE 300
Provider Business Mailing Address City Name:
LAS CRUCES
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-556-7767
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MOUNTAIN VIEW REGIONAL MEDICAL CENTE
Provider Second Line Business Practice Location Address:
4351 E LOHMAN AVENUE
Provider Business Practice Location Address City Name:
LAS CRUCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-556-7600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2020

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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