Healthcare Provider Details

I. General information

NPI: 1023068590
Provider Name (Legal Business Name): HOSPITALIST GROUP OF EL PASO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1626 MEDICAL CTR STE 503 5TH FLOOR
EL PASO TX
79902-5015
US

IV. Provider business mailing address

1626 MEDICAL CTR STE 503 5TH FLOOR
EL PASO TX
79902-5015
US

V. Phone/Fax

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

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
# 5
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: CLAY M. HEIGHTEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 972-739-3001