Provider Demographics
NPI:1336147644
Name:RIO GRANDE OB GYN GROUP, PA
Entity Type:Organization
Organization Name:RIO GRANDE OB GYN GROUP, PA
Other - Org Name:EL PASO OB GYN ASSOCIATES PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANMIGUEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-533-7579
Mailing Address - Street 1:PO BOX 843225
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-3225
Mailing Address - Country:US
Mailing Address - Phone:915-533-7579
Mailing Address - Fax:915-225-3832
Practice Address - Street 1:125 W HAGUE RD
Practice Address - Street 2:STE. 260
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5814
Practice Address - Country:US
Practice Address - Phone:915-533-7579
Practice Address - Fax:915-225-3832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156859401Medicaid
TX00508UMedicare PIN