1881678662 NPI number — SURGERY AFFILIATE OF EL PASO, LLC

Table of content: (NPI 1881678662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881678662 NPI number — SURGERY AFFILIATE OF EL PASO, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGERY AFFILIATE OF EL PASO, LLC
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:
1881678662
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 W CASTELLANO DR
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:
79912-6108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-532-8200
Provider Business Mailing Address Fax Number:
915-532-6979

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 W. CASTELLANO DRIVE
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:
79912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-532-8200
Provider Business Practice Location Address Fax Number:
915-532-6979
Provider Enumeration Date:
12/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BOON
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICER/AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
480-567-0269

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  006838 , 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: 0508630490 . This is a "EL PASO THOMASON OUTSOURC" identifier . This identifiers is of the category "OTHER".
  • Identifier: BP08630490 . This is a "BIEN VIVIR SENIOR HS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 490004280 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: GH08630490 . This is a "EL PASO FIRST GROUP HEALT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 177741300 . This is a "DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 087960301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 087960301 . This is a "EL PASO FIRST HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: A9316 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: CH08630490 . This is a "EL PASO FIRST CHIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: HH1522 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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