Provider Demographics
NPI:1295964070
Name:CITY OF EL PASO-DEPARTMENT OF PUBLIC HEALTH
Entity type:Organization
Organization Name:CITY OF EL PASO-DEPARTMENT OF PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODBAR
Authorized Official - Suffix:
Authorized Official - Credentials:CHFP
Authorized Official - Phone:915-771-5779
Mailing Address - Street 1:5151 EL PASO DRIVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2818
Mailing Address - Country:US
Mailing Address - Phone:915-771-5779
Mailing Address - Fax:915-771-5893
Practice Address - Street 1:5151 EL PASO DRIVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2818
Practice Address - Country:US
Practice Address - Phone:915-771-5779
Practice Address - Fax:915-771-5893
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF EL PASO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120978503Medicaid
TX120978504Medicaid
TX108331302Medicaid
TX120978505Medicaid
TX120978504Medicaid