MEDICARE: PRESIDIO MEDICAL CENTER

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	305R00000X	Preferred Provider Organization	305R00000X	TX

General Provider Information

NPI Number	:	1215172960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESIDIO MEDICAL CENTER

Provider Business Mailing Address
First Line	:	1375 LOMA VERDE DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-7812
Country	:	US
Telephone Number	:	915-373-0098
Fax Number	:	915-855-3311

Provider Business Practice Location Address
First Line	:	101 NORTH ERMA
Second Line	:
City	:	PRESIDIO
State	:	TX
Zip	:	79845
Country	:	US
Telephone Number	:	915-373-0098
Fax Number	:	915-855-3311

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. AJAI AGARWAL
Credential	:	M.D.
Telephone Number	:	915-373-0098

Provider Enumeration Date	:	12/10/2008
Last Update Date	:	12/10/2008

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Directions to “PRESIDIO MEDICAL CENTER ” Practice Location

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