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Hardik C Shah

Hospitalist

Allopathic & Osteopathic Physicians

820 Prudential Dr Ste 304, Jacksonville, FL 32207-8205

PECOS Enrollment

This provider is enrolled in PECOS as HARDIK SHAH.

Based on the most recent information from CMS, provider Hardik C Shah is legally eligible to order and refer claims for Part B, HHA and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 11:21 AM.

Profile Details

Provider ID
1750377784
Provider Type
Individual
Full Name
Shah, Hardik C
Title
Dr.
Credential
M.D.

Gender
Male
Sole Proprietor
No
Enumeration Date
9/26/2005
Last Updated
7/29/2024

Contact Information

Practice Location

820 Prudential Dr Ste 304, Jacksonville, FL 32207-8205

(904) 202-3860

(904) 202-3846

Mailing Location

PO Box 746638, Atlanta, GA 30374-6638

(904) 202-1032

(904) 376-4107

Provider Taxonomies

Code	Description	License
Code 208M00000X Primary	Description Hospitalist Allopathic & Osteopathic Physicians	License ME97803 Florida
Code 207R00000X	Description Internal Medicine Allopathic & Osteopathic Physicians	License ME97803 Florida
Code 207RG0300X	Description Internal Medicine Allopathic & Osteopathic Physicians	License 01058275 Indiana

Provider Identifiers

ID	Description	Issuer
ID 2778041-00	Description Medicaid	Issuer Unlisted Florida
ID P00469548	Description Other	Issuer RAILROAD MEDICARE Florida

Hardik C Shah

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

Saenz Maisonet, Jean Franc

Patel, Tushar Mohanbhai

Zoglman, Jason

Davison, Peter N

Wardan, Unnati

Shah, Faiza

Paing, Soe

Robison, William T

Ahmed, Naveed

Jones, Treva Latresse