Provider Demographics
NPI:1487659884
Name:PHYSICIANS SPECIALTY HOSPITAL OF EL PASO EAST LP
Entity Type:Organization
Organization Name:PHYSICIANS SPECIALTY HOSPITAL OF EL PASO EAST LP
Other - Org Name:PHYSICIANS HOSPITAL EAST
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR PATIENT ACCOUNTS
Authorized Official - Prefix:MISS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:I
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-849-5100
Mailing Address - Street 1:1416 GEORGE DIETER DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7601
Mailing Address - Country:US
Mailing Address - Phone:915-598-4240
Mailing Address - Fax:915-849-4767
Practice Address - Street 1:1416 GEORGE DIETER DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7601
Practice Address - Country:US
Practice Address - Phone:915-598-4240
Practice Address - Fax:915-849-4767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8013282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM59209321Medicaid
TXHH1042OtherBLUE CROSS BLUE SHIELD PR
NM59209321Medicaid