Provider Demographics
NPI:1821076233
Name:EL PASO PEDIATRIC ASSOC. P.A.
Entity Type:Organization
Organization Name:EL PASO PEDIATRIC ASSOC. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-593-2033
Mailing Address - Street 1:1160 SADDLE BRONC DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7045
Mailing Address - Country:US
Mailing Address - Phone:915-593-2033
Mailing Address - Fax:915-595-3916
Practice Address - Street 1:1160 SADDLE BRONC DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7045
Practice Address - Country:US
Practice Address - Phone:915-593-2033
Practice Address - Fax:915-595-3916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX091795701Medicaid
TX091795702Medicaid