Provider Demographics
NPI:1669655601
Name:EAST EL PASO PHYSICIANS' MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:EAST EL PASO PHYSICIANS' MEDICAL CENTER, LLC
Other - Org Name:LEGENT HOSPITAL OF EL PASO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CNO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-849-5133
Mailing Address - Street 1:4090 MAPLESHADE LN STE 200
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-0024
Mailing Address - Country:US
Mailing Address - Phone:817-421-1066
Mailing Address - Fax:
Practice Address - Street 1:1416 GEORGE DIETER DRIVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7601
Practice Address - Country:US
Practice Address - Phone:915-849-4749
Practice Address - Fax:915-598-4412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX450877Medicare Oscar/Certification