1174559389 NPI number — SHASHI S BELLUR MD PA

Table of content: (NPI 1174559389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174559389 NPI number — SHASHI S BELLUR MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHASHI S BELLUR MD PA
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:
6
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:
1174559389
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 RIVER POINTE DRIVE
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
CONROE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77304-2867
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-756-8484
Provider Business Mailing Address Fax Number:
936-756-8465

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 RIVER POINTE DRIVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
CONROE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77304-2867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-756-8484
Provider Business Practice Location Address Fax Number:
936-756-8465
Provider Enumeration Date:
06/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BELLUR
Authorized Official First Name:
SHASHI
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
936-756-8484

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 159912801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: DC9332 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00951U . This is a "BCBS OF TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com