Provider Demographics
NPI:1356419832
Name:M & C CHILDREN'S CLINIC
Entity type:Organization
Organization Name:M & C CHILDREN'S CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:O
Authorized Official - Last Name:USEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-546-4140
Mailing Address - Street 1:11800 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936
Mailing Address - Country:US
Mailing Address - Phone:915-546-4140
Mailing Address - Fax:915-546-4144
Practice Address - Street 1:11800 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936
Practice Address - Country:US
Practice Address - Phone:915-546-4140
Practice Address - Fax:915-546-4144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178243501Medicaid
TX178242701Medicaid
TXI49793Medicare UPIN