Basic Information
| Provider Information | |||||||||
| NPI: | 1457606808 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PHYSICIANS AND ALLIED HEALTH PROFESSIONALS GROUP, PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THE LAB CONNECTION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1626 MEDICAL CENTER DR | ||||||||
| Address2: | 400 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799025010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155218620 | ||||||||
| FaxNumber: | 9155469800 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 N OREGON ST | ||||||||
| Address2: | STE 500 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799023351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155218620 | ||||||||
| FaxNumber: | 9155469800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2012 | ||||||||
| LastUpdateDate: | 10/09/2012 | ||||||||
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| AuthorizedOfficialLastName: | HEIGHTEN | ||||||||
| AuthorizedOfficialFirstName: | CLAY | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9727393757 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PHYSICIANS AND ALLIED HEALTH PROFESSIONALS GROUP, PA | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.