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General NPI Number Information
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NPI Number | 1023143278
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Entity Type | Organization
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Legal Business Name | EL PASO DEL NORTE SURGICAL GROUP, PA
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 11/04/2008
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Provider Practice Location Address
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Address Line | 10175GATEWAY WEST BLVD. SUITE 220
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City | EL PASO
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State | TX
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Zip | 79925-7618
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Country | US
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Telephone | 915-591-7700
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Fax | 915-591-3170
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Provider Business Mailing Address
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Address Line | 10175GATEWAY WEST BLVD. SUITE 220
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City | EL PASO
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State | TX
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Zip | 79925-7618
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Country | US
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Telephone | 915-591-7700
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Fax | 915-591-3170
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JORGE ACOSTA
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Credential | M.D.
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Telephone | 915-591-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | L6246
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License Number State | TX
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