1366427130 NPI number — EL PASO SPECIALTY HOSPITAL LTD

Table of content: (NPI 1366427130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366427130 NPI number — EL PASO SPECIALTY HOSPITAL LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EL PASO SPECIALTY HOSPITAL LTD
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:
EL PASO SPECIALTY HOSPITAL
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:
1366427130
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1755 CURIE DRIVE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79902-2919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-544-3636
Provider Business Mailing Address Fax Number:
915-544-6114

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1755 CURIE DRIVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79902-2919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-544-3636
Provider Business Practice Location Address Fax Number:
915-544-6114
Provider Enumeration Date:
12/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CHAVEZ
Authorized Official First Name:
IRENE
Authorized Official Middle Name:
H
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
915-544-3636

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  007282 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , 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: 1483224-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH1001 . This is a "BLUE CROSS PROVIDER NUMBE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1483224-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com