Healthcare Provider Details

I. General information

NPI: 1003511676
Provider Name (Legal Business Name): EUNICE SHIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18511 HIGHLANDER MEDICS ST
FORT BLISS TX
79906-5327
US

IV. Provider business mailing address

18511 HIGHLANDER MEDICS ST
FORT BLISS TX
79906-5327
US

V. Phone/Fax

Practice location:
  • Phone: 915-742-0576
  • Fax:
Mailing address:
  • Phone: 915-742-0576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number0074452
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: