Basic Information
| Provider Information | |||||||||
| NPI: | 1689806234 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EL PASO ASC LP | ||||||||
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| OtherOrganizationName: | ENDOSCOPY CENTER OF EL PASO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 MURCHISON DR | ||||||||
| Address2: | SUITE 180 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799024842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155445000 | ||||||||
| FaxNumber: | 9155445001 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 MURCHISON DR | ||||||||
| Address2: | SUITE 180 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799024842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155445000 | ||||||||
| FaxNumber: | 9155445001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2009 | ||||||||
| LastUpdateDate: | 02/27/2014 | ||||||||
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| AuthorizedOfficialLastName: | CLENDENIN | ||||||||
| AuthorizedOfficialFirstName: | PHILLIP | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6156651283 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 8F33697 | 01 | TX | CRNA DUANE RIEGEL | OTHER | 8L20195 | 01 | TX | CRNA PATRICK HANDY | OTHER | 8F33696 | 01 | TX | CRNA RIC BARIBEAULT | OTHER | 8L23364 | 01 | TX | CRNA DARLENE MILLER | OTHER | 8F33695 | 01 | TX | CRNA LAURA GARCIA | OTHER | 8L23970 | 01 | TX | CRNA ROTH OWEN | OTHER | 8L25450 | 01 | TX | CRNA GLYNN COOPER | OTHER | 8L22433 | 01 | TX | CRNA JAMES BODOH | OTHER | 8L22432 | 01 | TX | CRNA JAMES MATTINGLY | OTHER | 8L21090 | 01 | TX | CRNA JASON GALES | OTHER | 8L219066 | 01 | TX | CRNA JOEL EHLER | OTHER |