MEDICARE: DOMINION MEDICAL SERVICES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	N3416	TX

General Provider Information

NPI Number	:	1881078285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOMINION MEDICAL SERVICES, PLLC

Provider Business Mailing Address
First Line	:	8623 N LOOP DR STE A
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79907-4520
Country	:	US
Telephone Number	:	915-881-4155
Fax Number	:	915-881-4172

Provider Business Practice Location Address
First Line	:	8623 N LOOP DR STE A
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79907-4520
Country	:	US
Telephone Number	:	915-881-4155
Fax Number	:	915-881-4172

Authorized Official
Title or Position	:	OWNER/ MD
Name	:	MR. ADEKUNLE ADEDAYO ADEDEJI
Credential	:	MD
Telephone Number	:	210-601-2367

Provider Enumeration Date	:	07/15/2015
Last Update Date	:	03/17/2026

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