| St. Jude International Cancer Associates, P.a. | |
|
1900 N Oregon St Suite 500 El Paso TX 79902-3351 | |
| (915) 544-8844 | |
| (915) 544-7650 |
| Full Name | St. Jude International Cancer Associates, P.a. |
|---|---|
| Speciality | Internal Medicine |
| Location | 1900 N Oregon St, El Paso, Texas |
| Authorized Official Name and Position | Ambrose Aboud (PRESIDENT) |
| Authorized Official Contact | 9155448844 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Jude International Cancer Associates, P.a. 5959 Gateway Blvd W Suite 120 El Paso TX 79925-3331 Ph: (915) 779-1716 | St. Jude International Cancer Associates, P.a. 1900 N Oregon St Suite 500 El Paso TX 79902-3351 Ph: (915) 544-8844 |
| NPI Number | 1538156922 |
|---|---|
| Provider Enumeration Date | 09/30/2005 |
| Last Update Date | 02/03/2015 |
| Medicare PECOS PAC ID | 8628027323 |
|---|---|
| Medicare Enrollment ID | O20050120000336 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538156922 | NPI | - | NPPES |
| 45D0509362 | Other | TX | CLIA ID NUMBER |
| 081412102 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | F9119 (Texas) | Primary |
| 207RH0003X | Internal Medicine - Hematology & Oncology | F9119 (Texas) | Secondary |
| Provider Name | Ambrose Aboud |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1407843873 PECOS PAC ID: 1153369582 Enrollment ID: I20090526000292 |
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