1396057436 NPI number — CARDIO DOPPLER OF EL PASO

Table of content: PATRICIA JEAN WURM GNP (NPI 1497729040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396057436 NPI number — CARDIO DOPPLER OF EL PASO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARDIO DOPPLER OF EL PASO
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:
6
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:
1396057436
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5424 PARAGUAY CT
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:
79903-5307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-525-4920
Provider Business Mailing Address Fax Number:
915-779-2951

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
811 CHELSEA ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79903-4925
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-544-3569
Provider Business Practice Location Address Fax Number:
915-779-2951
Provider Enumeration Date:
07/06/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ROSEMOND
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
PRESIDENT/DIRECTOR
Authorized Official Telephone Number:
915-525-4920

Provider Taxonomy Codes

  • Taxonomy code: 246XC2903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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