Provider Demographics
NPI:1477717460
Name:RAMESH R SHAH, .M.D, P.C.
Entity Type:Organization
Organization Name:RAMESH R SHAH, .M.D, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE BILLING
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-781-2616
Mailing Address - Street 1:1703 W 30TH ST
Mailing Address - Street 2:STE B
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-1603
Mailing Address - Country:US
Mailing Address - Phone:417-781-2616
Mailing Address - Fax:417-781-2934
Practice Address - Street 1:1703 W 30TH ST
Practice Address - Street 2:STE B
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1603
Practice Address - Country:US
Practice Address - Phone:417-781-2616
Practice Address - Fax:417-781-2934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-18
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100004110AMedicaid
KS100155780AMedicaid
MO201842408Medicaid
MO201842408Medicaid
MOMA1136Medicare PIN