Basic Information
| Provider Information | |||||||||
| NPI: | 1962722330 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EL PASO COUNTY HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | UNIVERSITY MEDICAL CENTER OF EL PASO | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4824 ALBERTA AVE | ||||||||
| Address2: | STE 403 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799052725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155441200 | ||||||||
| FaxNumber: | 9155217980 | ||||||||
| Practice Location | |||||||||
| Address1: | 2022 MURCHISON DR STE 108 | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799023058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155441200 | ||||||||
| FaxNumber: | 9155217980 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2010 | ||||||||
| LastUpdateDate: | 03/08/2012 | ||||||||
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| AuthorizedOfficialLastName: | VALENTI | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9155441200 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA0005X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Family Planning Facility |
ID Information
| ID | Type | State | Issuer | Description | 215466801 | 05 | TX | MEDICAID |