Basic Information
| Provider Information | |||||||||
| NPI: | 1225046360 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANI | ||||||||
| FirstName: | RAVI | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1015 MEDICAL CENTER BLVD | ||||||||
| Address2: | SUITE 1700 | ||||||||
| City: | WEBSTER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775984011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814040360 | ||||||||
| FaxNumber: | 2814804046 | ||||||||
| Practice Location | |||||||||
| Address1: | 1015 MEDICAL CENTER BLVD | ||||||||
| Address2: | SUITE 1700 | ||||||||
| City: | WEBSTER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775984011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814040360 | ||||||||
| FaxNumber: | 2814804046 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 10/20/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | H0110 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 100010838 | 01 | TX | MEDICARE RAILROAD | OTHER | 127647906 | 05 | TX | MEDICAID | 4071898 | 01 | TX | AETNA PROVIDER NUMBER | OTHER | 799 | 01 | TX | MHHNP | OTHER | 8436K0 | 01 | TX | BCBS PROVIDER # | OTHER |