Provider Demographics
NPI:1881678662
Name:SURGERY AFFILIATE OF EL PASO, LLC
Entity Type:Organization
Organization Name:SURGERY AFFILIATE OF EL PASO, LLC
Other - Org Name:FOUNDATION SURGERY AFFILIATE OF EL PASO, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-567-0269
Mailing Address - Street 1:125 W CASTELLANO DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-6108
Mailing Address - Country:US
Mailing Address - Phone:915-532-8200
Mailing Address - Fax:915-532-6979
Practice Address - Street 1:125 W. CASTELLANO DRIVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912
Practice Address - Country:US
Practice Address - Phone:915-532-8200
Practice Address - Fax:915-532-6979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX006838261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP08630490OtherBIEN VIVIR SENIOR HS
087960301OtherEL PASO FIRST HEALTH NET
177741300OtherDEPT OF LABOR
490004280OtherMEDICARE RAILROAD
HH1522OtherBLUE CROSS BLUE SHIELD
0508630490OtherEL PASO THOMASON OUTSOURC
GH08630490OtherEL PASO FIRST GROUP HEALT
CH08630490OtherEL PASO FIRST CHIP
NMA9316Medicaid
TX087960301Medicaid
ASC041Medicare PIN