Provider Demographics
NPI:1124360748
Name:EL PASO COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:EL PASO COUNTY HOSPITAL DISTRICT
Other - Org Name:UNIVERSITY MEDICAL CENTER FABENS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:CINTRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-521-7600
Mailing Address - Street 1:PO BOX 202507
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-2507
Mailing Address - Country:US
Mailing Address - Phone:915-521-2271
Mailing Address - Fax:915-521-2272
Practice Address - Street 1:101 POTASIO ST.
Practice Address - Street 2:
Practice Address - City:FABENS
Practice Address - State:TX
Practice Address - Zip Code:79838-3940
Practice Address - Country:US
Practice Address - Phone:915-521-2271
Practice Address - Fax:915-521-2272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-21
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
TX286953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2140198OtherPK
TX251002Medicaid