1558742411 NPI number — DR. JEET MEHTA M.D.

Table of content: DR. JEET MEHTA M.D. (NPI 1558742411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558742411 NPI number — DR. JEET MEHTA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEHTA
Provider First Name:
JEET
Provider Middle Name:
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:
1558742411
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1329 SW 16TH STREET SUITE 5130
Provider Second Line Business Mailing Address:
PO BOX 100288
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-273-9064
Provider Business Mailing Address Fax Number:
352-846-0314

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 SW ARCHER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32608-1135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-548-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2015

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: 207R00000X , with the licence number:  94-08581 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: ME147322 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 94-08581 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: ME147322 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1064362000 . This is a "GAINESVILLE VAMC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 118839700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".