| Eastside Medical Care Center, Pa | |
|
1721 N Lee Trevino Dr El Paso TX 79936-4521 | |
| (915) 590-9424 | |
| (915) 590-9049 |
| Full Name | Eastside Medical Care Center, Pa |
|---|---|
| Speciality | General Practice |
| Location | 1721 N Lee Trevino Dr, El Paso, Texas |
| Authorized Official Name and Position | Laurence Juarez (ADMINISTRATOR) |
| Authorized Official Contact | 9158420504 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Eastside Medical Care Center, Pa Po Box 12520 El Paso TX 79913-0520 Ph: (915) 842-0504 | Eastside Medical Care Center, Pa 1721 N Lee Trevino Dr El Paso TX 79936-4521 Ph: (915) 590-9424 |
| NPI Number | 1255318630 |
|---|---|
| Provider Enumeration Date | 12/28/2005 |
| Last Update Date | 12/19/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255318630 | NPI | - | NPPES |
| L0399 | Medicaid | NM | |
| CD3874 | Other | TX | PALMETTO GBA |
| 0858375-01 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 208D00000X | General Practice | (* (Not Available)) | Primary |
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