Provider Demographics
NPI:1932308624
Name:BHUPATRAI VACHHANI MD & MANOJ VAKIL
Entity Type:Organization
Organization Name:BHUPATRAI VACHHANI MD & MANOJ VAKIL
Other - Org Name:NORTH LOOP 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:713-869-0115
Mailing Address - Street 1:1801 NORTH LOOP W
Mailing Address - Street 2:SUITE 42
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1444
Mailing Address - Country:US
Mailing Address - Phone:713-869-0115
Mailing Address - Fax:713-869-9857
Practice Address - Street 1:1801 NORTH LOOP W
Practice Address - Street 2:SUITE 42
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1444
Practice Address - Country:US
Practice Address - Phone:713-869-0115
Practice Address - Fax:713-869-9857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2012-05-01
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
00SN47Medicare PIN
TX100279202Medicaid
TX085058801Medicaid
A83675Medicare UPIN