Provider Demographics
NPI:1891031035
Name:EL PASO HEALTHCARE PROVIDER NETWORK
Entity Type:Organization
Organization Name:EL PASO HEALTHCARE PROVIDER NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P.
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:REBOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-708-9700
Mailing Address - Street 1:98 SAN JACINTO BLVD.
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-4237
Mailing Address - Country:US
Mailing Address - Phone:512-708-9700
Mailing Address - Fax:
Practice Address - Street 1:98 SAN JACINTO BLVD.
Practice Address - Street 2:SUITE 1800
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-4237
Practice Address - Country:US
Practice Address - Phone:512-708-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty