Provider Demographics
NPI:1467996629
Name:EPMED, PA
Entity Type:Organization
Organization Name:EPMED, PA
Other - Org Name:LAS CRUCES PAIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:GENARO
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-598-7246
Mailing Address - Street 1:3215 GATEWAY BLVD W
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-4225
Mailing Address - Country:US
Mailing Address - Phone:915-598-7246
Mailing Address - Fax:915-633-6598
Practice Address - Street 1:880 S TELSHOR BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8682
Practice Address - Country:US
Practice Address - Phone:575-395-7246
Practice Address - Fax:575-652-4607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-07
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM58470701Medicaid