Basic Information
| Provider Information | |||||||||
| NPI: | 1528123072 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | SHAILESH | ||||||||
| MiddleName: | MANEKLAL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2880 TRICOM ST | ||||||||
| Address2: | |||||||||
| City: | NORTH CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294069171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437975050 | ||||||||
| FaxNumber: | 8437973633 | ||||||||
| Practice Location | |||||||||
| Address1: | 2880 TRICOM ST | ||||||||
| Address2: | |||||||||
| City: | NORTH CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294069171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437975050 | ||||||||
| FaxNumber: | 8437973633 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2006 | ||||||||
| LastUpdateDate: | 03/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 29727 | SC | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 208100000X | 29727 | SC | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208VP0000X | 29727 | SC | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 208VP0014X | 29727 | SC | N | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 2081P2900X | 29727 | SC | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 30165827 | 01 | SC | SELECT HEALTH PROVIDER ID | OTHER | 220471 | 01 | SC | MEDCOST PROVIDER NO. | OTHER | D043 | 01 | SC | ARCIS HEALTHCARE MEDICARE GROUP PTAN | OTHER | DE3528 | 01 | SC | MEDICAID DME PTAN | OTHER | 7623566 | 01 | SC | CIGNA PROVIDER ID | OTHER | 965426 | 01 | SC | WELLCARE PROVIDER ID | OTHER | AA20541701 | 01 | SC | MEDICARE GROUP | OTHER | P01291314 | 01 | SC | RAILROAD MEDICARE PTAN | OTHER | 1902246077 | 01 | SC | ARCIS HEALTHCARE GROUP NPI | OTHER | 42D2000692 | 01 | SC | ARCIS HEALTHCARE CLIA CERTIFICATION NO. | OTHER | DE3538 | 01 | SC | MEDICAID DME PTAN | OTHER | DU4331 | 01 | SC | RAILROAD MEDICARE GROUP PTAN | OTHER | 4271747 / 1572888 | 01 | SC | COVENTRY NETWORKS PROVIDER NO. & CPD ID NO. | OTHER | 56162 | 01 | SC | MEDCOST GROUP PAYER ID | OTHER | DE3537 | 01 | SC | MEDICAID DME PTAN | OTHER | 45168 | 01 | SC | MULTIPLAN GROUP NO. | OTHER | 570634057 | 01 | SC | GROUP TAX ID | OTHER | 9343063 | 01 | SC | AETNA PROVIDER ID | OTHER | DE3694 | 01 | SC | MEDICAID DME PTAN | OTHER | GP6337 | 01 | SC | ARCIS HEALTHCARE MEDICAID GROUP PTAN | OTHER | AA2054 | 01 | SC | MEDICARE NUMBER | OTHER | DE3539 | 01 | SC | MEDICAID DME PTAN | OTHER |