Healthcare Provider Details

I. General information

NPI: 1508987165
Provider Name (Legal Business Name): EP MEDICAL IMAGING TECHNOLOGY, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10767 GATEWAY BLVD W SUITE 520
EL PASO TX
79935-4919
US

IV. Provider business mailing address

10767 GATEWAY BLVD W SUITE 520
EL PASO TX
79935-4919
US

V. Phone/Fax

Practice location:
  • Phone: 915-598-3888
  • Fax:
Mailing address:
  • Phone: 915-598-3888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEANETTE TAN
Title or Position: VICE PRESIDENT OF GENERAL PARTNER
Credential: M.D.
Phone: 915-598-3888