| Shylesh Ganta ,md , Pa | |
|
3401 Greenbriar Ste 100 Midland TX 79707-4607 | |
| (432) 683-6558 | |
| (432) 682-5104 |
| Full Name | Shylesh Ganta ,md , Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 3401 Greenbriar Ste 100, Midland, Texas |
| Authorized Official Name and Position | Shylesh Ganta (DIRECTOR) |
| Authorized Official Contact | 4327708286 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shylesh Ganta ,md , Pa Po Box 4083 Midland TX 79704-4083 Ph: (432) 683-6558 | Shylesh Ganta ,md , Pa 3401 Greenbriar Ste 100 Midland TX 79707-4607 Ph: (432) 683-6558 |
| NPI Number | 1124217310 |
|---|---|
| Provider Enumeration Date | 10/24/2007 |
| Last Update Date | 07/01/2010 |
| Medicare PECOS PAC ID | 8123109998 |
|---|---|
| Medicare Enrollment ID | O20080117000662 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124217310 | NPI | - | NPPES |
| 192864001 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | K9066 (Texas) | Primary |
| Provider Name | Shylesh R Ganta |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811900657 PECOS PAC ID: 2264522598 Enrollment ID: I20071226000218 |
| Provider Name | Sapna Chilka |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790972610 PECOS PAC ID: 7214018092 Enrollment ID: I20080117000672 |
| Provider Name | Tiffany Boen Hansen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750794749 PECOS PAC ID: 7911126446 Enrollment ID: I20140916001858 |
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