Provider Demographics
NPI:1265782676
Name:BHOOT SURGICAL INC
Entity type:Organization
Organization Name:BHOOT SURGICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NILESH
Authorized Official - Middle Name:HARILAL
Authorized Official - Last Name:BHOOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-500-9999
Mailing Address - Street 1:2520 HONOLULU AVE
Mailing Address - Street 2:160
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1853
Mailing Address - Country:US
Mailing Address - Phone:818-500-9999
Mailing Address - Fax:
Practice Address - Street 1:2520 HONOLULU AVE
Practice Address - Street 2:160
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1853
Practice Address - Country:US
Practice Address - Phone:818-476-5656
Practice Address - Fax:818-248-0999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2016-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94735208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9419340Medicaid
CA9419340Medicaid