Provider Demographics
NPI:1508987165
Name:EP MEDICAL IMAGING TECHNOLOGY, LP
Entity Type:Organization
Organization Name:EP MEDICAL IMAGING TECHNOLOGY, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-598-3888
Mailing Address - Street 1:10767 GATEWAY BLVD W
Mailing Address - Street 2:SUITE 520
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-4919
Mailing Address - Country:US
Mailing Address - Phone:915-598-3888
Mailing Address - Fax:
Practice Address - Street 1:10767 GATEWAY BLVD W
Practice Address - Street 2:SUITE 520
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-4919
Practice Address - Country:US
Practice Address - Phone:915-598-3888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00465290OtherMEDICARE RAILROAD
TXFTXN08Medicare PIN