1770536120 NPI number — EL PASO HEALTHCARE SYSTEM LTD

Table of content: (NPI 1770536120)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770536120 NPI number — EL PASO HEALTHCARE SYSTEM LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EL PASO HEALTHCARE SYSTEM 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:
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:
1770536120
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1801 N OREGON 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:
79902-3524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-521-1200
Provider Business Mailing Address Fax Number:
915-544-5203

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 N OREGON 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:
79902-3524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-521-1200
Provider Business Practice Location Address Fax Number:
915-544-5203
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HAYS
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
915-521-1670

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00000935 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 450646B00000 . This is a "SECTION 1011" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7100001130 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 82158200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 95018552 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: COL0107N , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003110294 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 078891 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100104530B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 135727105 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 450107B000000 . This is a "SECTION 1011" identifier . This identifiers is of the category "OTHER".
  • Identifier: HH0591 . This is a "BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001189471 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01822797 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100701490B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 433654000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4500107 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 487420000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: A5115 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0131650 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




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