Provider Demographics
NPI:1285028951
Name:MESA HILLS SPECIALTY HOSPITAL OPERATOR LLC
Entity Type:Organization
Organization Name:MESA HILLS SPECIALTY HOSPITAL OPERATOR LLC
Other - Org Name:PREMIER SPECIALTY HOSPITAL OF EL PASO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMACHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-545-1823
Mailing Address - Street 1:2311 N OREGON ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3216
Mailing Address - Country:US
Mailing Address - Phone:915-545-1823
Mailing Address - Fax:
Practice Address - Street 1:2311 N OREGON ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3216
Practice Address - Country:US
Practice Address - Phone:915-532-3941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-20
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QA1903X, 282E00000X, 283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX353570001Medicaid
TX452035Medicare Oscar/Certification