Basic Information
| Provider Information | |||||||||
| NPI: | 1932240629 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHWEST EAR NOSE & THROAT CONSULTANTS PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 MEDICAL CENTER | ||||||||
| Address2: | STE 101 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799025008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155441350 | ||||||||
| FaxNumber: | 9155446740 | ||||||||
| Practice Location | |||||||||
| Address1: | 5959 GATEWAY BLVD W | ||||||||
| Address2: | STE. 120 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799253331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9157791716 | ||||||||
| FaxNumber: | 9157716558 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2007 | ||||||||
| LastUpdateDate: | 08/06/2008 | ||||||||
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| AuthorizedOfficialLastName: | BRIGHT | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 9155441350 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | K7250 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist | 207Y00000X | J9716 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | L7891 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | K7250 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 085285701 | 05 | TX | MEDICAID | 00T50W | 01 | TX | BCBS | OTHER |