=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487102521
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOUSTON RADIATION PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2016
-----------------------------------------------------
Last Update Date | 09/19/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5113 LOCUST ST
-----------------------------------------------------
City | BELLAIRE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77401-3320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-630-8181
-----------------------------------------------------
Fax | 713-838-9708
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5113 LOCUST ST
-----------------------------------------------------
City | BELLAIRE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77401-3320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-630-8181
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SANJAY C MEHTA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 713-630-8181
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | K9353
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------