MEDICARE: KINGSWAY MEDICAL CENTER PLLC

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	133V00000X	Registered Dietitian
2	207Q00000X	Family Medicine Physician	N3416	TX
3	207QG0300X	Geriatric Medicine (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	:	1851647911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGSWAY MEDICAL CENTER PLLC

Provider Business Mailing Address
First Line	:	8623 N LOOP DR STE A
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79907-4520
Country	:	US
Telephone Number	:	915-881-4155
Fax Number	:	915-881-4172

Provider Business Practice Location Address
First Line	:	8623 N LOOP DR STE A
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79907-4520
Country	:	US
Telephone Number	:	915-881-4155
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	ADEKUNLE ADEDEJI
Credential	:	M.D.
Telephone Number	:	210-601-2367

Provider Enumeration Date	:	07/26/2012
Last Update Date	:	04/08/2026

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