Provider Demographics
NPI:1912274853
Name:VIOLETA RADENOVICH, MD, PA
Entity Type:Organization
Organization Name:VIOLETA RADENOVICH, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-577-9339
Mailing Address - Street 1:1250 E CLIFF DR STE 4D
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4846
Mailing Address - Country:US
Mailing Address - Phone:915-577-9339
Mailing Address - Fax:915-541-1237
Practice Address - Street 1:1250 E CLIFF DR STE 4D
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4846
Practice Address - Country:US
Practice Address - Phone:915-577-9339
Practice Address - Fax:915-541-1237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0160261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K0160OtherMEDICAL LICENSE
TX126563902Medicaid
G24990Medicare UPIN
TX126563902Medicaid