Provider Demographics
NPI:1912963869
Name:MAHESH B. PATEL
Entity Type:Organization
Organization Name:MAHESH B. PATEL
Other - Org Name:BRADSHAW MEDICAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAHESH
Authorized Official - Middle Name:B
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-967-5034
Mailing Address - Street 1:PO BOX 240
Mailing Address - Street 2:
Mailing Address - City:BRADSHAW
Mailing Address - State:WV
Mailing Address - Zip Code:24817-0240
Mailing Address - Country:US
Mailing Address - Phone:304-967-5034
Mailing Address - Fax:304-906-2417
Practice Address - Street 1:9981 MARSHALL HIGHWAY
Practice Address - Street 2:
Practice Address - City:BRADSHAW
Practice Address - State:WV
Practice Address - Zip Code:24817
Practice Address - Country:US
Practice Address - Phone:304-967-5034
Practice Address - Fax:304-906-2417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0034884000Medicaid
WV513889Medicare Oscar/Certification