| |
1420 Geronimo Drive Building C, Suite B El Paso TX 79925-1855 | |
(915) 343-9702 | |
Not Available |
Full Name | |
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Speciality | Nurse Practitioner |
Location | 1420 Geronimo Drive, El Paso, Texas |
Authorized Official Name and Position | Alfredo Madrid (OWNER) |
Authorized Official Contact | 9153439702 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1420 Geronimo Drive Building C, Suite B El Paso TX 79925-1855 Ph: (915) 343-9702 | 1420 Geronimo Drive Building C, Suite B El Paso TX 79925-1855 Ph: (915) 343-9702 |
NPI Number | 1427897834 |
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Provider Enumeration Date | 05/23/2024 |
Last Update Date | 09/09/2024 |
Medicare PECOS PAC ID | 8325583107 |
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Medicare Enrollment ID | O20240717000143 |
Identifier | Type | State | Issuer |
---|---|---|---|
1427897834 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Primary |
Provider Name | Alfredo Madrid |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1649815978 PECOS PAC ID: 4385070572 Enrollment ID: I20200206001992 |
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