1326020140 NPI number — EL PASO CARDIAC VASCULAR & THORACIC SURGEONS PA

Table of content: (NPI 1326020140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326020140 NPI number — EL PASO CARDIAC VASCULAR & THORACIC SURGEONS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EL PASO CARDIAC VASCULAR & THORACIC SURGEONS PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1326020140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 N OREGON ST
Provider Second Line Business Mailing Address:
STE 750
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79902-3584
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-542-0400
Provider Business Mailing Address Fax Number:
915-542-1188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 N OREGON ST
Provider Second Line Business Practice Location Address:
STE 750
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79902-3584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-542-0400
Provider Business Practice Location Address Fax Number:
915-542-1188
Provider Enumeration Date:
11/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CORRAL
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
HUMBERTO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
915-542-0400

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0049AU . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 000X3247 . This is a "SALUD PROGRAMS MEDICAID" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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