MEDICARE: EL PASO ANESTHESIOLOGY SERVICES PA

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DA2172	OTHER	TX	RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1063412591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EL PASO ANESTHESIOLOGY SERVICES PA

Provider Business Mailing Address
First Line	:	5959 GATEWAY BLVD WEST
Second Line	:	SUITE 120
City	:	EL PASO
State	:	TX
Zip	:	79925-3315
Country	:	US
Telephone Number	:	915-779-1716
Fax Number	:	915-771-6496

Provider Business Practice Location Address
First Line	:	5959 GATEWAY BLVD WEST
Second Line	:	SUITE 120
City	:	EL PASO
State	:	TX
Zip	:	79925-3315
Country	:	US
Telephone Number	:	915-779-1716
Fax Number	:	915-771-6496

Authorized Official
Title or Position	:	CREDENTIALING MGR
Name	:	ANGIE VASQUEZ
Credential	:
Telephone Number	:	915-779-1716

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	04/24/2014

5959 GATEWAY WEST , STE 160
EL PASO, TX
79925-3315

Practice Phone: 915-779-5866
Practice Fax: 915-779-8604

5959 GATEWAY WEST , STE 160
EL PASO, TX
79925-3315