1700937869 NPI number — EL PASO PSYCHIATRIC ASSOCIATES PA

Table of content: (NPI 1700937869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700937869 NPI number — EL PASO PSYCHIATRIC ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EL PASO PSYCHIATRIC ASSOCIATES 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:
ALTERNATIVES CENTRE FOR BEHAVIORAL HEALTH
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:
1700937869
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7760 ALABAMA ST
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:
79904-3136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-757-7999
Provider Business Mailing Address Fax Number:
915-757-8004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7760 ALABAMA ST
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:
79904-3136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-757-7999
Provider Business Practice Location Address Fax Number:
915-757-8004
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON-JIMENEZ
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
915-757-7999

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0850X , with the licence number: 875-A , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X , with the licence number: 875-A , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X , with the licence number: 875-A , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: HH5066 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 021302701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH6759 . This is a "BLUE CROSS BLUE SHIELD OF" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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