Provider Demographics
NPI:1518682467
Name:PBC MEDI GROUP LLC
Entity Type:Organization
Organization Name:PBC MEDI GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GILBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:ENRIQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-269-9150
Mailing Address - Street 1:121 PARAGON LN STE C
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-6315
Mailing Address - Country:US
Mailing Address - Phone:915-545-2525
Mailing Address - Fax:915-544-0962
Practice Address - Street 1:121 PARAGON LN STE C
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-6315
Practice Address - Country:US
Practice Address - Phone:915-545-2525
Practice Address - Fax:915-544-0962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-04
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No343800000XTransportation ServicesSecured Medical Transport (VAN)