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General NPI Number Information
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NPI Number | 1922309632
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Entity Type | Organization
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Legal Business Name | BASANTI VRUSHAB MD PLLC
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Dates
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Enumeration Date | 11/11/2010
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Last Update Date | 11/16/2010
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Provider Practice Location Address
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Address Line | 1615 PRECINCT LINE RD STE 101
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City | HURST
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State | TX
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Zip | 76054-3345
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Country | US
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Telephone | 817-281-4910
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Fax | 817-281-3107
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Provider Business Mailing Address
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Address Line | 1615 PRECINCT LINE RD STE 101
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City | HURST
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State | TX
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Zip | 76054-3345
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Country | US
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Telephone | 817-281-4910
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Fax | 817-281-3107
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. STACY LEE REEVES
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Credential |
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Telephone | 817-281-4910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | M6940
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License Number State | TX
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