Provider Demographics
NPI:1174559389
Name:SHASHI S BELLUR MD PA
Entity type:Organization
Organization Name:SHASHI S BELLUR MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHASHI
Authorized Official - Middle Name:S
Authorized Official - Last Name:BELLUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-756-8484
Mailing Address - Street 1:600 RIVER POINTE DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2867
Mailing Address - Country:US
Mailing Address - Phone:936-756-8484
Mailing Address - Fax:936-756-8465
Practice Address - Street 1:600 RIVER POINTE DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2867
Practice Address - Country:US
Practice Address - Phone:936-756-8484
Practice Address - Fax:936-756-8465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159912801Medicaid
TXDC9332OtherRAILROAD MEDICARE
TX00951UOtherBCBS OF TX
TX00951UMedicare ID - Type Unspecified