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NPI Code Detail

MEDICARE: JGGPO CORPORATION

MEDICARE: JGGPO CORPORATION
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
1261QR0401XComprehensive Outpatient Rehabilitation Facility (CORF)454863TX

General Provider Information

NPI Number : 1063588564
Entity Type Code : Organization
Provider Name (Legal Business Name) : JGGPO CORPORATION
Provider Business Mailing Address
First Line : 7806 GATEWAY EAST #100
Second Line :
City : EL PASO
State : TX
Zip : 79915-1806
Country : US
Telephone Number : 915-566-7584
Fax Number : 915-566-7682
Provider Business Practice Location Address
First Line : 7806 GATEWAY BLVD E STE 100
Second Line :
City : EL PASO
State : TX
Zip : 79915-1806
Country : US
Telephone Number : 915-566-7584
Fax Number : 915-566-7682
Authorized Official
Title or Position : CHIEF OPERATING OFFICER
Name : DARREN ANTHONY PRATT
Credential : COO
Telephone Number : 915-566-7584
Provider Enumeration Date : 11/27/2006
Last Update Date : 08/19/2009

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Directions to “JGGPO CORPORATION ” Practice Location

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