Provider Demographics
NPI:1609075399
Name:BHUPATRAI VACHHANI MD & MANOJ VAKIL MD PTR
Entity Type:Organization
Organization Name:BHUPATRAI VACHHANI MD & MANOJ VAKIL MD PTR
Other - Org Name:ANTOINE OFFICE
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:PEDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-686-1835
Mailing Address - Street 1:6503 ANTOINE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77091-1203
Mailing Address - Country:US
Mailing Address - Phone:713-686-1835
Mailing Address - Fax:713-686-0379
Practice Address - Street 1:6503 ANTOINE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77091-1203
Practice Address - Country:US
Practice Address - Phone:713-686-1835
Practice Address - Fax:713-686-0379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123959204Medicaid
TX100279202Medicaid
TX085058801Medicaid
TX890577Medicare PIN
TX00SN47Medicare PIN
TX123959204Medicaid
TX085058801Medicaid
TX890576Medicare PIN