Provider Demographics
NPI:1932144409
Name:EL PASO HEART AND VASCULAR CLINIC, P.A.
Entity Type:Organization
Organization Name:EL PASO HEART AND VASCULAR CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:WINKLER
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-225-0410
Mailing Address - Street 1:1700 N OREGON ST
Mailing Address - Street 2:SUITE 630
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3584
Mailing Address - Country:US
Mailing Address - Phone:915-225-0410
Mailing Address - Fax:915-225-0419
Practice Address - Street 1:1700 N OREGON ST
Practice Address - Street 2:SUITE 630
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3584
Practice Address - Country:US
Practice Address - Phone:915-225-0410
Practice Address - Fax:915-225-0419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158594501Medicaid
TX158594501Medicaid