Provider Demographics
NPI:1770613572
Name:CITY OF EL PASO TEXAS
Entity type:Organization
Organization Name:CITY OF EL PASO TEXAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE SERVICES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GALLEGOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-212-6508
Mailing Address - Street 1:5115 EL PASO DR STE A
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:915-212-6512
Mailing Address - Fax:915-212-0168
Practice Address - Street 1:5115 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 TEXAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251K00000X
45DO895373251K00000X
251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120978502Medicaid
TX120978502Medicaid
TXPH0009Medicare PIN