Provider Demographics
NPI:1295970820
Name:MEHTA, SACHIN (MD)
Entity type:Individual
Prefix:
First Name:SACHIN
Middle Name:
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 N IH 35
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1926
Mailing Address - Country:US
Mailing Address - Phone:512-324-8300
Mailing Address - Fax:512-324-8301
Practice Address - Street 1:4207 JAMES CASEY ST
Practice Address - Street 2:SUITE 317
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-3300
Practice Address - Country:US
Practice Address - Phone:512-324-3447
Practice Address - Fax:512-324-3448
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN1393207RI0011X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204078404Medicaid
TX8EN446OtherBCBS
TX204078405Medicaid
TX8EQ059OtherBCBS
TX363212YL9XMedicare PIN
TX8EQ059OtherBCBS
TX8L16752Medicare PIN