1861538985 NPI number — KAMALSINGH M RATHOD MD

Table of content: (NPI 1861538985)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861538985 NPI number — KAMALSINGH M RATHOD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAMALSINGH M RATHOD MD
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:
GRAYSON MEDICAL CONSULTANTS PA
Provider Other Organization Name Type Code:
3
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:
1861538985
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
321 N HIGHLAND AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
SHERMAN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75092-7386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-893-1011
Provider Business Mailing Address Fax Number:
866-240-2131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
321 N HIGHLAND AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SHERMAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75092-7386
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-893-1011
Provider Business Practice Location Address Fax Number:
866-240-2131
Provider Enumeration Date:
01/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RATHOD
Authorized Official First Name:
KAMALSINGH
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
903-893-1011

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X , with the licence number:  G4690 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0200X , with the licence number: G6377 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00BX53 . This is a "BLUE SHIELD, TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 081847801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100755220A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: CN9442 . This is a "RAIL ROAD MEDICARE PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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