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General NPI Number Information
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NPI Number | 1770541435
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Entity Type | Organization
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Legal Business Name | WEST TEXAS PROVIDER SERVICES LLC
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 200 BARTLETT DR SUITE 108
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City | EL PASO
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State | TX
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Zip | 79912-1628
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Country | US
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Telephone | 915-581-7960
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Fax | 915-584-7599
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Provider Business Mailing Address
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Address Line | 200 BARTLETT DR SUITE 108
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City | EL PASO
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State | TX
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Zip | 79912-1628
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Country | US
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Telephone | 915-581-7960
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Fax | 915-584-7599
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Authorized Official
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Title or Position | PRESIDENT
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Name | DON D PENDERGRAS
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Credential |
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Telephone | 915-581-6644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 33BP3500X
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License Number State | TX
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