Provider Demographics
NPI:1003910365
Name:DR RAJESH K. SHROFF
Entity Type:Organization
Organization Name:DR RAJESH K. SHROFF
Other - Org Name:DR RAJESH K. SHROFF
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHROFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-624-0009
Mailing Address - Street 1:ONE MERCY LANE STE 305
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913
Mailing Address - Country:US
Mailing Address - Phone:501-624-0009
Mailing Address - Fax:
Practice Address - Street 1:ONE MERCY LANE STE 305
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913
Practice Address - Country:US
Practice Address - Phone:501-624-0009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR3441174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102488001Medicaid
ARD04907Medicare UPIN
AR102488001Medicaid