Basic Information
| Provider Information | |||||||||
| NPI: | 1508987165 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EP MEDICAL IMAGING TECHNOLOGY, LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10767 GATEWAY BLVD W | ||||||||
| Address2: | SUITE 520 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799354919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155983888 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10767 GATEWAY BLVD W | ||||||||
| Address2: | SUITE 520 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799354919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155983888 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2007 | ||||||||
| LastUpdateDate: | 05/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | TAN | ||||||||
| AuthorizedOfficialFirstName: | JEANETTE | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF GENERAL PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 9155983888 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085R0001X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0202X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085U0001X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound |
ID Information
| ID | Type | State | Issuer | Description | P00465290 | 01 | TX | MEDICARE RAILROAD | OTHER |