MEDICARE: DR. MAHENDRA G. JAIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	K4317	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P01316143	OTHER	TX	RR MEDICARE
6	P01626934	OTHER	TX	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8FT489	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	8EB467	OTHER	TX	BCBS
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063414985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAHENDRA G. JAIN M.D.

Provider Business Mailing Address
First Line	:	8520 BROADWAY ST
Second Line	:	SUITE 200
City	:	PEARLAND
State	:	TX
Zip	:	77584-7716
Country	:	US
Telephone Number	:	281-485-4050
Fax Number	:	281-485-6850

Provider Business Practice Location Address
First Line	:	8520 BROADWAY ST
Second Line	:	SUITE 200
City	:	PEARLAND
State	:	TX
Zip	:	77584-7716
Country	:	US
Telephone Number	:	281-485-4050
Fax Number	:	281-485-6850

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	01/11/2017

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Directions to “ DR. MAHENDRA G. JAIN M.D.” Practice Location

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