Basic Information
| Provider Information | |||||||||
| NPI: | 1104258151 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NEURONETEX VENTURE EL PASO LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COMPLETE EMERGENCY CARE EL PASO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 92545 | ||||||||
| Address2: | |||||||||
| City: | SOUTHLAKE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760920545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174210035 | ||||||||
| FaxNumber: | 8174210036 | ||||||||
| Practice Location | |||||||||
| Address1: | 655 E REDD RD | ||||||||
| Address2: | 201 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799121218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174210035 | ||||||||
| FaxNumber: | 8174210036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2013 | ||||||||
| LastUpdateDate: | 01/25/2016 | ||||||||
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| AuthorizedOfficialLastName: | NEIMAN | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | BRAXTON | ||||||||
| AuthorizedOfficialTitleorPosition: | GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 8174210035 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | ESQ. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0002X | Y | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care |
No ID Information.