Healthcare Provider Details

I. General information

NPI: 1740671106
Provider Name (Legal Business Name): HVS-MHT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S BRYANT AVE STE 101
EDMOND OK
73034-6330
US

IV. Provider business mailing address

105 S BRYANT AVE STE 101
EDMOND OK
73034-6330
US

V. Phone/Fax

Practice location:
  • Phone: 405-622-3063
  • Fax:
Mailing address:
  • Phone: 405-622-3063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number27981
License Number StateOK

VIII. Authorized Official

Name: DR. RAKESH SHRIVASTAVA
Title or Position: OWNER / PRESIDENT
Credential: M.D.
Phone: 405-622-3063