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NPI Code Detail

MEDICARE: TEXAS UROGYNECOLOGY & LASER SURGERY CENTER PA

MEDICARE: TEXAS UROGYNECOLOGY & LASER SURGERY CENTER 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
1207VG0400XGynecology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10096SGOTHERTXBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1528201373
Entity Type Code : Organization
Provider Name (Legal Business Name) : TEXAS UROGYNECOLOGY & LASER SURGERY CENTER PA
Provider Business Mailing Address
First Line : 4501 N MESA ST
Second Line :
City : EL PASO
State : TX
Zip : 79912-6101
Country : US
Telephone Number : 915-533-5600
Fax Number : 915-533-5604
Provider Business Practice Location Address
First Line : 4501 N MESA ST
Second Line :
City : EL PASO
State : TX
Zip : 79912-6101
Country : US
Telephone Number : 915-533-5600
Fax Number : 915-533-5604
Authorized Official
Title or Position : PRESIDENT
Name : DR. RICHARD W FARNAM
Credential : M.D.
Telephone Number : 915-487-2558
Provider Enumeration Date : 04/09/2009
Last Update Date : 10/29/2021

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Directions to “TEXAS UROGYNECOLOGY & LASER SURGERY CENTER PA ” Practice Location

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