| Mittal Medical Group, Pa | |
|
3904 101st St Lubbock TX 79423-5725 | |
| (512) 321-3278 | |
| Not Available |
| Full Name | Mittal Medical Group, Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 3904 101st St, Lubbock, Texas |
| Authorized Official Name and Position | Piyush Mittal (PRESIDENT) |
| Authorized Official Contact | 4088214246 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mittal Medical Group, Pa 3904 101st St Lubbock TX 79423-5725 Ph: (512) 321-3278 | Mittal Medical Group, Pa 3904 101st St Lubbock TX 79423-5725 Ph: (512) 321-3278 |
| NPI Number | 1275863516 |
|---|---|
| Provider Enumeration Date | 01/08/2010 |
| Last Update Date | 01/08/2010 |
| Medicare PECOS PAC ID | 4183752991 |
|---|---|
| Medicare Enrollment ID | O20100514000168 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275863516 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Piyush Mittal |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447250923 PECOS PAC ID: 0042292435 Enrollment ID: I20040601000774 |
| Provider Name | Shirley A Mcreynolds |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346547627 PECOS PAC ID: 6103009477 Enrollment ID: I20110323000899 |
| Provider Name | Julia Gulley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366830705 PECOS PAC ID: 1951627728 Enrollment ID: I20150313001656 |
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