MEDICARE: MT WEST HEALTH 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
1	207Q00000X	Family 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

General Provider Information

NPI Number	:	1720098700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MT WEST HEALTH CENTER PA

Provider Business Mailing Address
First Line	:	PO BOX 13203
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79913-3203
Country	:	US
Telephone Number	:	915-217-2793
Fax Number	:	915-584-8546

Provider Business Practice Location Address
First Line	:	6151 DEW DR STE 410
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-3912
Country	:	US
Telephone Number	:	915-584-8124
Fax Number	:	915-584-8546

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. LUIS A VILLALOBOS
Credential	:	M.S
Telephone Number	:	915-584-7920

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	12/02/2024

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Directions to “MT WEST HEALTH CENTER PA ” Practice Location

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