Provider Demographics
NPI:1508328196
Name:PERCY-CHARLES MEDICAL CENTER, P.A.
Entity Type:Organization
Organization Name:PERCY-CHARLES MEDICAL CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PERCY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-594-2772
Mailing Address - Street 1:2200 N LEE TREVINO DR STE A3
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-3419
Mailing Address - Country:US
Mailing Address - Phone:915-594-2772
Mailing Address - Fax:915-594-2774
Practice Address - Street 1:2200 N LEE TREVINO DR STE A3
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-3419
Practice Address - Country:US
Practice Address - Phone:915-594-2772
Practice Address - Fax:915-594-2774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2023-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty