1669647376 NPI number — DR. ALLAN SEBASTIAN GANESH D.P.M

Table of content: DR. ALLAN SEBASTIAN GANESH D.P.M (NPI 1669647376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669647376 NPI number — DR. ALLAN SEBASTIAN GANESH D.P.M

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GANESH
Provider First Name:
ALLAN
Provider Middle Name:
SEBASTIAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669647376
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
834 SWIFT WATER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABILENE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79602-8170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-259-1786
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6200 REGIONAL PLZ
Provider Second Line Business Practice Location Address:
SUITE# 1450
Provider Business Practice Location Address City Name:
ABILENE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79606-5250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-480-1177
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  PO3274 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: 1862 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8AW296 . This is a "BLUE CROSS BLUE SHIELD PROVIDER #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00677666 . This is a "RAIL ROAD MEDICARE GROUP MEMBER PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 195625201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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