1306867890 NPI number — PHYSICAL MEDICINE AND REHABILITATION ASSOCIATES OF EL PASO, P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306867890 NPI number — PHYSICAL MEDICINE AND REHABILITATION ASSOCIATES OF EL PASO, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICAL MEDICINE AND REHABILITATION ASSOCIATES OF EL PASO, P.A.
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:
1306867890
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 26217
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:
79926-6217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-598-8120
Provider Business Mailing Address Fax Number:
915-598-8121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1397 GEORGE DIETER DR STE D
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:
79936-7410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-598-8120
Provider Business Practice Location Address Fax Number:
915-598-8121
Provider Enumeration Date:
07/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SANDBERG
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OFFICER
Authorized Official Telephone Number:
915-598-8120

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  H6574 , 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)





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