1033185459 NPI number — SYLVESTER D PHIFER M.D.

Table of content: SYLVESTER D PHIFER M.D. (NPI 1033185459)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033185459 NPI number — SYLVESTER D PHIFER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHIFER
Provider First Name:
SYLVESTER
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1033185459
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1837 PASEO REAL CIR
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:
79936-3722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-549-9005
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10301 GATEWAY BLVD W
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:
79925-7701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-535-9275
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  E8109 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 89013 . This is a "AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: GH05820081 . This is a "EL PASO FIRST GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 85611Y . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: CH05820081 . This is a "EL PASO FIRST CHIPS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 300107925 . This is a "MEDICARE RR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 742939272 . This is a "TAX ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: MDE8109TX . This is a "WORKERS COMP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 100819 . This is a "SUPERIOR SSI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00F2883 . This is a "MEDICAID NEWMEXICO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 131754702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201012760 . This is a "MEDICAID PRESBYTERIAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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