Provider Demographics
NPI:1356359897
Name:B RAI MEHTA MD
Entity type:Organization
Organization Name:B RAI MEHTA MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:IRVING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-417-0973
Mailing Address - Street 1:550 S CARRIER PKWY
Mailing Address - Street 2:450
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-1500
Mailing Address - Country:US
Mailing Address - Phone:817-417-0973
Mailing Address - Fax:817-417-7266
Practice Address - Street 1:550 S CARRIER PKWY
Practice Address - Street 2:450
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-1500
Practice Address - Country:US
Practice Address - Phone:817-417-0973
Practice Address - Fax:817-417-7266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007944174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161011501Medicaid
TX161011502Medicaid
TX161011502Medicaid
TX161011501Medicaid