| Ganesan, Llc | |
|
2242 Nw 39th St Oklahoma City OK 73112-8884 | |
| (405) 627-9263 | |
| Not Available |
| Full Name | Ganesan, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2242 Nw 39th St, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Mena Ganesan (CEO) |
| Authorized Official Contact | 4056279263 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ganesan, Llc 2701 N Walker Ave Oklahoma City OK 73103-1326 Ph: () - | Ganesan, Llc 2242 Nw 39th St Oklahoma City OK 73112-8884 Ph: (405) 627-9263 |
| NPI Number | 1750914560 |
|---|---|
| Provider Enumeration Date | 02/20/2020 |
| Last Update Date | 08/23/2024 |
| Certification Date | 08/23/2024 |
| Medicare PECOS PAC ID | 7113354507 |
|---|---|
| Medicare Enrollment ID | O20200225000388 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750914560 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Mena P Ganesan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669787198 PECOS PAC ID: 1951618693 Enrollment ID: I20150914001464 |
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