Provider Demographics
NPI:1326317322
Name:ANKUR D MEHTA DO PA
Entity Type:Organization
Organization Name:ANKUR D MEHTA DO PA
Other - Org Name:TX SPINE AND JOINT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER & OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANKUR
Authorized Official - Middle Name:D
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:832-849-0909
Mailing Address - Street 1:5535 MEMORIAL DR
Mailing Address - Street 2:SUITE F-816
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-8021
Mailing Address - Country:US
Mailing Address - Phone:832-849-0909
Mailing Address - Fax:
Practice Address - Street 1:8830 LONG POINT RD
Practice Address - Street 2:SUITE 502
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-3040
Practice Address - Country:US
Practice Address - Phone:832-849-0909
Practice Address - Fax:832-849-0910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP00097208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDS6455OtherRR MEDICARE
TXDS6455OtherRR MEDICARE