MEDICARE: MPD OPERATORS EL PASO LLC

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	314000000X	Skilled Nursing Facility		TX

General Provider Information

NPI Number	:	1619408796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MPD OPERATORS EL PASO LLC

Provider Business Mailing Address
First Line	:	101 N 2ND ST
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-3266
Country	:	US
Telephone Number	:	318-812-2140
Fax Number	:

Provider Business Practice Location Address
First Line	:	7441 PASEO DEL NORTE
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79911-3158
Country	:	US
Telephone Number	:	318-812-2140
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DAWNE SMITH
Credential	:
Telephone Number	:	318-812-2140

Provider Enumeration Date	:	03/21/2017
Last Update Date	:	03/21/2017

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