Provider Demographics
NPI:1730351073
Name:MEHTA MEDICAL SERVICES
Entity type:Organization
Organization Name:MEHTA MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HASUMATI
Authorized Official - Middle Name:V
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-323-4091
Mailing Address - Street 1:PO BOX 87169
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-7169
Mailing Address - Country:US
Mailing Address - Phone:910-323-4091
Mailing Address - Fax:910-323-4092
Practice Address - Street 1:518 SANDHURST DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4426
Practice Address - Country:US
Practice Address - Phone:910-323-4091
Practice Address - Fax:910-323-4092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20167207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC208795OtherMEDICARE INDIVIDUAL
NC8958493Medicaid
NC02145OtherBCBS GROUP
NC0323OtherMEDICARE GROUP
NCC85496Medicare UPIN