Provider Demographics
NPI:1487034120
Name:ABILENE INTERNAL MEDICINE ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:ABILENE INTERNAL MEDICINE ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GANESH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:325-795-9288
Mailing Address - Street 1:6200 REGIONAL PLZ
Mailing Address - Street 2:SUITE 1450
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5250
Mailing Address - Country:US
Mailing Address - Phone:325-795-9288
Mailing Address - Fax:
Practice Address - Street 1:6200 REGIONAL PLZ
Practice Address - Street 2:SUITE 1450
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5250
Practice Address - Country:US
Practice Address - Phone:325-795-9288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1049207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty