MEDICARE: EL PASO DEL NORTE SURGICAL GROUP, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician
2	174400000X	Specialist	L6246	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0022LE	OTHER	TX	BCBS GROUP PROVIDER NUMB
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023143278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EL PASO DEL NORTE SURGICAL GROUP, PA

Provider Business Mailing Address
First Line	:	10175GATEWAY WEST BLVD.
Second Line	:	SUITE 220
City	:	EL PASO
State	:	TX
Zip	:	79925-7618
Country	:	US
Telephone Number	:	915-591-7700
Fax Number	:	915-591-3170

Provider Business Practice Location Address
First Line	:	10175GATEWAY WEST BLVD.
Second Line	:	SUITE 220
City	:	EL PASO
State	:	TX
Zip	:	79925-7618
Country	:	US
Telephone Number	:	915-591-7700
Fax Number	:	915-591-3170

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JORGE ACOSTA
Credential	:	M.D.
Telephone Number	:	915-591-7700

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	11/04/2008

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Directions to “EL PASO DEL NORTE SURGICAL GROUP, PA ” Practice Location

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