Provider Demographics
NPI:1275690232
Name:I. H. SHAH, M.D. AND S. HASAN, M.D. AND ASSOCIATES
Entity Type:Organization
Organization Name:I. H. SHAH, M.D. AND S. HASAN, M.D. AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP PRACTITIONER GENERAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:IQTIDAR
Authorized Official - Middle Name:U H
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-408-7130
Mailing Address - Street 1:4004 MEDICAL PARKWAY
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401
Mailing Address - Country:US
Mailing Address - Phone:903-455-4414
Mailing Address - Fax:903-455-1944
Practice Address - Street 1:4004 MEDICAL PARKWAY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401
Practice Address - Country:US
Practice Address - Phone:903-455-4414
Practice Address - Fax:903-455-1944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0365208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081898101Medicaid
TX00CH50Medicare PIN
TXD69073Medicare UPIN