1619215365 NPI number — O MEARA ROSADO DPM PLLC

Table of content: (NPI 1619215365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619215365 NPI number — O MEARA ROSADO DPM PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
O MEARA ROSADO DPM PLLC
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:
FOOT AND ANKLE PARTNERS OF EL PASO
Provider Other Organization Name Type Code:
3
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:
1619215365
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1397 GEORGE DIETER DR STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79936-7681
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-503-2020
Provider Business Mailing Address Fax Number:
915-996-9574

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7300 REMCON CIR STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79912-1643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-503-2020
Provider Business Practice Location Address Fax Number:
915-996-9574
Provider Enumeration Date:
01/30/2013

Additional Information

Authorized Official

Authorized Official Last Name:
O'MEARA
Authorized Official First Name:
SEAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PART OWNER
Authorized Official Telephone Number:
915-525-1069

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  1835 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 323780202 . This is a "MEDICAID DME" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 3237802-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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