Provider Demographics
NPI:1881038859
Name:EL PASO OBGYN
Entity Type:Organization
Organization Name:EL PASO OBGYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEWIS-LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:915-231-2286
Mailing Address - Street 1:PO BOX 574
Mailing Address - Street 2:
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986-0574
Mailing Address - Country:US
Mailing Address - Phone:304-356-5030
Mailing Address - Fax:304-536-5031
Practice Address - Street 1:7430 REMCON CIR
Practice Address - Street 2:BLDG A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3514
Practice Address - Country:US
Practice Address - Phone:915-231-2286
Practice Address - Fax:915-833-7312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-22
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5278207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM73625825Medicaid
TX0013YVOtherBCBS
TX3233181.01Medicaid
NM73625825Medicaid