Provider Demographics
NPI:1215172960
Name:PRESIDIO MEDICAL CENTER
Entity type:Organization
Organization Name:PRESIDIO MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AJAI
Authorized Official - Middle Name:
Authorized Official - Last Name:AGARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-373-0098
Mailing Address - Street 1:1375 LOMA VERDE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7812
Mailing Address - Country:US
Mailing Address - Phone:915-373-0098
Mailing Address - Fax:915-855-3311
Practice Address - Street 1:101 NORTH ERMA
Practice Address - Street 2:
Practice Address - City:PRESIDIO
Practice Address - State:TX
Practice Address - Zip Code:79845
Practice Address - Country:US
Practice Address - Phone:915-373-0098
Practice Address - Fax:915-855-3311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX305R00000X305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization