Provider Demographics
NPI:1679588396
Name:PAN AMERICAN GENERAL HOSPITAL
Entity Type:Organization
Organization Name:PAN AMERICAN GENERAL HOSPITAL
Other - Org Name:SOUTHWESTERN GENERAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:9154-969-6000
Mailing Address - Street 1:1221 N COTTON ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3015
Mailing Address - Country:US
Mailing Address - Phone:915-496-9600
Mailing Address - Fax:915-496-9641
Practice Address - Street 1:1221 N COTTON ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3015
Practice Address - Country:US
Practice Address - Phone:915-496-9600
Practice Address - Fax:915-496-9641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000252282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX450760Medicare ID - Type Unspecified