Provider Demographics
NPI:1578532123
Name:COMPREHENSIVE CARDIOVASCULAR MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:COMPREHENSIVE CARDIOVASCULAR MEDICAL GROUP, INC.
Other - Org Name:VIRAL Y. MEHTA, MD, FACC, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRAL
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-631-5544
Mailing Address - Street 1:5945 TRUXTUN AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0610
Mailing Address - Country:US
Mailing Address - Phone:661-631-5544
Mailing Address - Fax:661-631-5546
Practice Address - Street 1:5945 TRUXTUN AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0610
Practice Address - Country:US
Practice Address - Phone:661-631-5544
Practice Address - Fax:661-631-5546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CK4808OtherMEDICARE RAILROAD
CAGR0088670Medicaid
ZZZ01507ZOtherBLUE SHIELD
ZZZ18798ZMedicare ID - Type Unspecified
CAGR0088670Medicaid