Provider Demographics
NPI:1922559327
Name:PHYSICIANS WEST EL PASO SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:PHYSICIANS WEST EL PASO SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP-MANAGED CARE CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-875-5025
Mailing Address - Street 1:3540 S BOULEVARD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5541
Mailing Address - Country:US
Mailing Address - Phone:405-875-5025
Mailing Address - Fax:
Practice Address - Street 1:820 E REDD RD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-7221
Practice Address - Country:US
Practice Address - Phone:405-875-5025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical