Basic Information
| Provider Information | |||||||||
| NPI: | 1811135080 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EL PASO COUNTY HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | UNIVERSITY MEDICAL CENTER - FABENS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 POTASIO | ||||||||
| Address2: | |||||||||
| City: | FABENS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 798383940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155441200 | ||||||||
| FaxNumber: | 9155217920 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 POTASIO | ||||||||
| Address2: | |||||||||
| City: | FABENS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 798383940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155441200 | ||||||||
| FaxNumber: | 9155217920 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2009 | ||||||||
| LastUpdateDate: | 10/17/2019 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CINTRON | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9155217600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | 00263 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | 092072001 | 05 | TX | MEDICAID | 092072002 | 05 | TX | MEDICAID | 458619 | 01 | TX | PTAN | OTHER |