Provider Demographics
NPI:1528201373
Name:TEXAS UROGYNECOLOGY & LASER SURGERY CENTER PA
Entity Type:Organization
Organization Name:TEXAS UROGYNECOLOGY & LASER SURGERY CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:FARNAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-487-2558
Mailing Address - Street 1:4501 N MESA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-6101
Mailing Address - Country:US
Mailing Address - Phone:915-533-5600
Mailing Address - Fax:915-533-5604
Practice Address - Street 1:4501 N MESA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-6101
Practice Address - Country:US
Practice Address - Phone:915-533-5600
Practice Address - Fax:915-533-5604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-09
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0096SGOtherBLUE CROSS BLUE SHIELD
TX0A3924Medicare PIN