Healthcare Provider Details

I. General information

NPI: 1548595671
Provider Name (Legal Business Name): EL PASO HOSPITALIST GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1626 MEDICAL CENTER DR STE 400 4TH FLOOR
EL PASO TX
79902-5000
US

IV. Provider business mailing address

1626 MEDICAL CENTER DR STE 400 4TH FLOOR
EL PASO TX
79902-5000
US

V. Phone/Fax

Practice location:
  • Phone: 915-546-9200
  • Fax: 915-546-9800
Mailing address:
  • Phone: 915-546-9200
  • Fax: 915-546-9800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: CLAY HEIGHTEN
Title or Position: PRESIDENT
Credential: MD
Phone: 972-739-3001