Healthcare Provider Details

I. General information

NPI: 1881038859
Provider Name (Legal Business Name): EL PASO OBGYN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7430 REMCON CIR BLDG A
EL PASO TX
79912-3514
US

IV. Provider business mailing address

PO BOX 574
WHITE SULPHUR SPRINGS WV
24986-0574
US

V. Phone/Fax

Practice location:
  • Phone: 915-231-2286
  • Fax: 915-833-7312
Mailing address:
  • Phone: 304-356-5030
  • Fax: 304-536-5031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberF5278
License Number StateTX

VIII. Authorized Official

Name: DR. NEIL M LEWIS-LEVINE
Title or Position: OWNER
Credential: DO
Phone: 915-231-2286