Provider Demographics
NPI:1699815944
Name:EL PASO NEUROSURGERY CENTER, P.A.
Entity Type:Organization
Organization Name:EL PASO NEUROSURGERY CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANKER
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNDRANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-590-1890
Mailing Address - Street 1:10400 VISTA DEL SOL DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7945
Mailing Address - Country:US
Mailing Address - Phone:915-590-1890
Mailing Address - Fax:915-590-1952
Practice Address - Street 1:10400 VISTA DEL SOL DR
Practice Address - Street 2:SUITE 104
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7945
Practice Address - Country:US
Practice Address - Phone:915-590-1890
Practice Address - Fax:915-590-1952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2019207T00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2057267-01Medicaid
NM34039376Medicaid
NM64186OtherPRESBYTERIAN SALUD
TX8B1328OtherBLUE CROSS OF TEXAS
200402600OtherUS DEPT OF LABOR
7450354OtherAETNA
TX2057267-01Medicaid
TX5631890001Medicare NSC