1023068590 NPI number — HOSPITALIST GROUP OF EL PASO PA

Table of content: (NPI 1023068590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023068590 NPI number — HOSPITALIST GROUP OF EL PASO PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPITALIST GROUP OF EL PASO 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:
1023068590
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1626 MEDICAL CTR STE 503
Provider Second Line Business Mailing Address:
5TH FLOOR
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79902-5015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-546-9200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1626 MEDICAL CTR STE 503
Provider Second Line Business Practice Location Address:
5TH FLOOR
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79902-5015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-546-9200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HEIGHTEN
Authorized Official First Name:
CLAY
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
972-739-3001

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 23707348 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 158220702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 158220701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0040KK . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 158220703 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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