Provider Demographics
NPI:1194733626
Name:B RAI MEHTA, MD PA
Entity type:Organization
Organization Name:B RAI MEHTA, MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
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 1:3295 S COOPER ST
Mailing Address - Street 2:137
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2363
Mailing Address - Country:US
Mailing Address - Phone:817-417-0973
Mailing Address - Fax:817-417-7266
Practice Address - Street 1:3295 S COOPER ST
Practice Address - Street 2:137
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2363
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:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX452592174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094268201Medicaid
TXHH6225OtherBLUEE CROSS BLUE SHIELD
TX094268202Medicaid
TXHH6225OtherBLUEE CROSS BLUE SHIELD
TXC19270Medicare UPIN