| Immunize El Paso | |
|
1400 George Dieter Dr Ste 260 El Paso TX 79936-7658 | |
| (915) 533-3414 | |
| (915) 533-3515 |
| Full Name | Immunize El Paso |
|---|---|
| Speciality | Family Medicine |
| Location | 1400 George Dieter Dr Ste 260, El Paso, Texas |
| Authorized Official Name and Position | Henry Brutus (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9155322771 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Immunize El Paso Po Box 962505 El Paso TX 79996-2505 Ph: (915) 533-3414 | Immunize El Paso 1400 George Dieter Dr Ste 260 El Paso TX 79936-7658 Ph: (915) 533-3414 |
| NPI Number | 1093853418 |
|---|---|
| Provider Enumeration Date | 02/01/2007 |
| Last Update Date | 07/07/2021 |
| Medicare PECOS PAC ID | 8022915008 |
|---|---|
| Medicare Enrollment ID | O20050524001042 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093853418 | NPI | - | NPPES |
| 017972302 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | K6973 (Texas) | Primary |
| 251K00000X | Public Health Or Welfare | K6973 (Texas) | Secondary |
| Provider Name | Scott K Silvia |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558453670 PECOS PAC ID: 6204884265 Enrollment ID: I20050106000117 |
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