Healthcare Provider Details

I. General information

NPI: 1326114869
Provider Name (Legal Business Name): EL PASO CENTER FOR GASTROINTESTINAL ENDOSCOPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 N MESA
EL PASO TX
79902-3595
US

IV. Provider business mailing address

1620 N MESA
EL PASO TX
79902-3595
US

V. Phone/Fax

Practice location:
  • Phone: 915-545-5300
  • Fax: 915-532-1413
Mailing address:
  • Phone: 915-545-5300
  • Fax: 915-532-1413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number008549
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PETER BLACH
Title or Position: OFFICER/AUTHORIZED OFFICIAL
Credential:
Phone: 713-343-0832