Provider Demographics
NPI:1164056859
Name:BIMAL R SHAH MD PC
Entity Type:Organization
Organization Name:BIMAL R SHAH MD PC
Other - Org Name:HEART & VASCULAR ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BIMAL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-722-1249
Mailing Address - Street 1:820 SAINT SEBASTIAN WAY STE 2A
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2636
Mailing Address - Country:US
Mailing Address - Phone:706-722-1249
Mailing Address - Fax:
Practice Address - Street 1:820 SAINT SEBASTIAN WAY STE 2A
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2636
Practice Address - Country:US
Practice Address - Phone:706-722-1249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-03
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty