Provider Demographics
NPI:1023143278
Name:EL PASO DEL NORTE SURGICAL GROUP, PA
Entity type:Organization
Organization Name:EL PASO DEL NORTE SURGICAL GROUP, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-591-7700
Mailing Address - Street 1:10175GATEWAY WEST BLVD.
Mailing Address - Street 2:SUITE 220
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7618
Mailing Address - Country:US
Mailing Address - Phone:915-591-7700
Mailing Address - Fax:915-591-3170
Practice Address - Street 1:10175GATEWAY WEST BLVD.
Practice Address - Street 2:SUITE 220
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7618
Practice Address - Country:US
Practice Address - Phone:915-591-7700
Practice Address - Fax:915-591-3170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208600000X
TXL6246174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0022LEOtherBCBS GROUP PROVIDER NUMB
TX166859201Medicaid
TX00163XMedicare PIN