MEDICARE: EL PASO HEALTHCARE PROVIDER NETWORK

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	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1891031035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EL PASO HEALTHCARE PROVIDER NETWORK

Provider Business Mailing Address
First Line	:	98 SAN JACINTO BLVD.
Second Line	:	SUITE 1800
City	:	AUSTIN
State	:	TX
Zip	:	78701-4237
Country	:	US
Telephone Number	:	512-708-9700
Fax Number	:

Provider Business Practice Location Address
First Line	:	98 SAN JACINTO BLVD.
Second Line	:	SUITE 1800
City	:	AUSTIN
State	:	TX
Zip	:	78701-4237
Country	:	US
Telephone Number	:	512-708-9700
Fax Number	:

Authorized Official
Title or Position	:	V.P.
Name	:	MR. JOHN C. REBOK
Credential	:
Telephone Number	:	512-708-9700

Provider Enumeration Date	:	12/17/2012
Last Update Date	:	12/17/2012

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