1801857743 NPI number — DR. JASHBHAI N PATEL M.D.

Table of content: DR. JASHBHAI N PATEL M.D. (NPI 1801857743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801857743 NPI number — DR. JASHBHAI N PATEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
JASHBHAI
Provider Middle Name:
N
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:
1801857743
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 PLANTATION DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHLANDS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24641-2790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-935-6476
Provider Business Mailing Address Fax Number:
276-935-7270

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1520 SLATE CREEK RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
GRUNDY
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24614-6975
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-935-6476
Provider Business Practice Location Address Fax Number:
276-395-4430
Provider Enumeration Date:
03/30/2006

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: 208600000X , with the licence number:  0101033235 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 007374551 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1308637 . This is a "FUNDS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0128711000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 017128500 . This is a "BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: P 00295752 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 001876 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 64663222 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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