Basic Information
| Provider Information | |||||||||
| NPI: | 1033316765 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VISTA SURGERY CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 COMMON DRIVE | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155954375 | ||||||||
| FaxNumber: | 9159758262 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 COMMON DRIVE | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155954375 | ||||||||
| FaxNumber: | 9159758262 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2007 | ||||||||
| LastUpdateDate: | 07/06/2022 | ||||||||
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| AuthorizedOfficialLastName: | ELLMAN | ||||||||
| AuthorizedOfficialFirstName: | MARC | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9155954375 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 07/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.