Healthcare Provider Details

I. General information

NPI: 1437790318
Provider Name (Legal Business Name): EPMED, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 N WILSHIRE BLVD
ROSWELL NM
88201-6519
US

IV. Provider business mailing address

3215 GATEWAY BLVD W STE 210
EL PASO TX
79903-4225
US

V. Phone/Fax

Practice location:
  • Phone: 575-395-7246
  • Fax:
Mailing address:
  • Phone: 915-598-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: EDUARDO GENARO VAZQUEZ
Title or Position: CEO
Credential:
Phone: 915-598-7246