Healthcare Provider Details

I. General information

NPI: 1467524231
Provider Name (Legal Business Name): SOUTHWEST X-RAY,LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 12/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10501 GATEWAY BLVD W SUITE 140
EL PASO TX
79925-7934
US

IV. Provider business mailing address

PO BOX 220122
EL PASO TX
79913-2122
US

V. Phone/Fax

Practice location:
  • Phone: 915-544-7300
  • Fax: 15-544-7301
Mailing address:
  • Phone: 915-833-3500
  • Fax: 915-833-3509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License NumberR28783
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberR28783
License Number StateTX

VIII. Authorized Official

Name: JESUS FERNANDO ESCARZAGA
Title or Position: PRESIDENT
Credential: RDMS
Phone: 915-833-3500