Basic Information
| Provider Information | |||||||||
| NPI: | 1891725479 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | VIREN | ||||||||
| MiddleName: | JASHVANTLAL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 634706 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452630001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8652923000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 111 HWY 70 E | ||||||||
| Address2: | |||||||||
| City: | DICKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370552080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154460446 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 11/12/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD39146 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 009936542 | 05 | AL | MEDICAID | 3325174 | 05 | TN | MEDICAID | P00293441 | 01 | TN | RAILROAD MEDICARE | OTHER | 4154439 | 01 | TN | BLUECROSS | OTHER | 806918263B | 05 | GA | MEDICAID | 009911938 | 05 | AL | MEDICAID | 3325175 | 05 | TN | MEDICAID | 4118465 | 01 | TN | BLUECROSS | OTHER | 806918263C | 05 | GA | MEDICAID | 4118464 | 01 | TN | BCBS OF TENNESSEE | OTHER |