| Paisano Medical Center, Lp | |
|
5340 El Paso Dr Ste A El Paso TX 79905-2838 | |
| (915) 778-9811 | |
| (915) 778-1521 |
| Full Name | Paisano Medical Center, Lp |
|---|---|
| Speciality | Family Medicine |
| Location | 5340 El Paso Dr Ste A, El Paso, Texas |
| Authorized Official Name and Position | Robert M Kaufman (TENANT) |
| Authorized Official Contact | 9157789811 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Paisano Medical Center, Lp 5340 El Paso Dr Ste A El Paso TX 79905-2838 Ph: (915) 778-9811 | Paisano Medical Center, Lp 5340 El Paso Dr Ste A El Paso TX 79905-2838 Ph: (915) 778-9811 |
| NPI Number | 1386631448 |
|---|---|
| Provider Enumeration Date | 10/04/2005 |
| Last Update Date | 02/23/2021 |
| Medicare PECOS PAC ID | 4688745391 |
|---|---|
| Medicare Enrollment ID | O20080623000578 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386631448 | NPI | - | NPPES |
| 161063601 | Medicaid | TX | |
| TP1153702901 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 522056 (Texas) | Primary |
| Provider Name | Robert Michael Kaufman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174574537 PECOS PAC ID: 9931271731 Enrollment ID: I20110131000809 |
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