Provider Demographics
NPI:1013112549
Name:MENTIS NEURO EL PASO, LLC
Entity type:Organization
Organization Name:MENTIS NEURO EL PASO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:L
Authorized Official - Last Name:QUIGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-864-8996
Mailing Address - Street 1:6565 WEST LOOP SOUTH
Mailing Address - Street 2:STE. 410
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3519
Mailing Address - Country:US
Mailing Address - Phone:713-820-4200
Mailing Address - Fax:713-820-4220
Practice Address - Street 1:4360 DONIPHAN DRIVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79922
Practice Address - Country:US
Practice Address - Phone:915-351-4441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH005BOtherBLUE CROSS