1477845683 NPI number — EL PASO NEUROLOGICAL INSTITUTE, PA

Table of content: (NPI 1477845683)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477845683 NPI number — EL PASO NEUROLOGICAL INSTITUTE, PA

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:
EL PASO NEUROLOGICAL INSTITUTE, 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:
1477845683

Entity Type Code:
Organization

Replacement NPI:

Last Update Date:
08/29/2011

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5959 GATEWAY BLVD W

Provider Second Line Business Mailing Address:
120

Provider Business Mailing Address City Name:
EL PASO

Provider Business Mailing Address State Name:
TX

Provider Business Mailing Address Postal Code:
79925-3331

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
915-779-1716

Provider Business Mailing Address Fax Number:
915-771-6496

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3270 JOE BATTLE BLVD

Provider Second Line Business Practice Location Address:
235

Provider Business Practice Location Address City Name:
EL PASO

Provider Business Practice Location Address State Name:
TX

Provider Business Practice Location Address Postal Code:
79938-2639

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
915-504-6890

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:
05/05/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ADZOTOR

Authorized Official First Name:
KWAZI

Authorized Official Middle Name:

Authorized Official Title or Position:
DIRECTOR/MD

Authorized Official Telephone Number:
915-504-6890

Provider Taxonomy Codes

Taxonomy code: 207R00000X , with the licence number: N8602 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Taxonomy code: 2084N0400X , with the licence number: N8602 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .