Provider Demographics
NPI:1417594607
Name:JORGE ACOSTA, MD, FACS, PA
Entity Type:Organization
Organization Name:JORGE ACOSTA, MD, FACS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-591-7700
Mailing Address - Street 1:1655 MOSSWOOD ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-3435
Mailing Address - Country:US
Mailing Address - Phone:915-591-7700
Mailing Address - Fax:915-591-3170
Practice Address - Street 1:1655 MOSSWOOD ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-3435
Practice Address - Country:US
Practice Address - Phone:915-591-7700
Practice Address - Fax:915-591-3170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty