Provider Demographics
NPI:1609981018
Name:UNITED MEDICAL WALK-IN CLINIC, PA
Entity Type:Organization
Organization Name:UNITED MEDICAL WALK-IN CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BORREGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-240-8656
Mailing Address - Street 1:3101 FORNEY LN
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-1607
Mailing Address - Country:US
Mailing Address - Phone:915-240-8656
Mailing Address - Fax:915-595-2231
Practice Address - Street 1:3101 FORNEY LN
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-1607
Practice Address - Country:US
Practice Address - Phone:915-317-6033
Practice Address - Fax:915-595-2231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3476207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM3476OtherTEXAS MEDICAL LICENSE
N0146239OtherTX DPS
NMMD2005-0204OtherNEW MEXICO MEDICAL LIC
05922968OtherECFMG NUMBER
05922968OtherECFMG NUMBER