Provider Demographics
NPI:1467524231
Name:SOUTHWEST X-RAY,LP
Entity Type:Organization
Organization Name:SOUTHWEST X-RAY,LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:FERNANDO
Authorized Official - Last Name:ESCARZAGA
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS
Authorized Official - Phone:915-833-3500
Mailing Address - Street 1:PO BOX 220122
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79913-2122
Mailing Address - Country:US
Mailing Address - Phone:915-833-3500
Mailing Address - Fax:915-833-3509
Practice Address - Street 1:10501 GATEWAY BLVD W
Practice Address - Street 2:SUITE 140
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7934
Practice Address - Country:US
Practice Address - Phone:915-544-7300
Practice Address - Fax:015-544-7301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR28783261QR0200X, 293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FTCXUNV1OtherMEDICARE ID
TX1690422-02Medicaid
TXFTCXUNV1Medicare UPIN