Healthcare Provider Details

I. General information

NPI: 1851647911
Provider Name (Legal Business Name): KINGSWAY MEDICAL CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8623 N LOOP DR STE A
EL PASO TX
79907-4520
US

IV. Provider business mailing address

8623 N LOOP DR STE A
EL PASO TX
79907-4520
US

V. Phone/Fax

Practice location:
  • Phone: 915-881-4155
  • Fax:
Mailing address:
  • Phone: 915-881-4155
  • Fax: 915-881-4172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberN3416
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ADEKUNLE ADEDEJI
Title or Position: OWNER/PROVIDER
Credential: M.D.
Phone: 210-601-2367