MEDICARE: EL PASO PHYSICIAN GROUP PA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	208600000X	Surgery Physician
2	207Q00000X	Family Medicine Physician
3	208000000X	Pediatrics Physician
4	207V00000X	Obstetrics & Gynecology Physician
5	363A00000X	Physician Assistant
6	363L00000X	Nurse Practitioner
7	111N00000X	Chiropractor
8	133V00000X	Registered Dietitian
9	225100000X	Physical Therapist
10	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0042KP	OTHER	TX	BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679524011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EL PASO PHYSICIAN GROUP PA

Provider Business Mailing Address
First Line	:	9229 LBJ FWY
Second Line	:	SUITE 250
City	:	DALLAS
State	:	TX
Zip	:	75243-3405
Country	:	US
Telephone Number	:	972-739-3097
Fax Number	:

Provider Business Practice Location Address
First Line	:	1626 MEDICAL CENTER DR
Second Line	:	5TH FLOOR, SUITE 503
City	:	EL PASO
State	:	TX
Zip	:	79902-5010
Country	:	US
Telephone Number	:	915-546-9200
Fax Number	:	915-546-9800

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CLAY M. HEIGHTEN
Credential	:	M.D.
Telephone Number	:	972-739-3001

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	06/10/2008

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Directions to “EL PASO PHYSICIAN GROUP PA ” Practice Location

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