Basic Information
Provider Information | |||||||||
NPI: | 1518124452 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SHAH | ||||||||
FirstName: | MEHA | ||||||||
MiddleName: | M | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 975341 | ||||||||
Address2: |   | ||||||||
City: | DALLAS | ||||||||
State: | TX | ||||||||
PostalCode: | 753975341 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9727911224 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1105 CENTRAL EXPY N | ||||||||
Address2: | SUITE 235 | ||||||||
City: | ALLEN | ||||||||
State: | TX | ||||||||
PostalCode: | 750136103 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9727476042 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/19/2008 | ||||||||
LastUpdateDate: | 06/30/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 0116017559 | VA | N |   | Allopathic & Osteopathic Physicians | Hospitalist |   | 207R00000X | N7348 | TX | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 208M00000X | 0101251693 | VA | N |   | Allopathic & Osteopathic Physicians | Hospitalist |   |
ID Information
ID | Type | State | Issuer | Description | 350022YLP1 | 01 | TX | SAIMS TRAVIS MEDICARE | OTHER | 350022YLP2 | 01 | TX | SAIMS ROT MEDICARE | OTHER |