Provider Demographics
NPI:1528505708
Name:EL PASO INTEGRATED PHYSICIANS GROUP
Entity type:Organization
Organization Name:EL PASO INTEGRATED PHYSICIANS GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GALBIATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-532-2400
Mailing Address - Street 1:4532 N MESA STREET STE 1A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912
Mailing Address - Country:US
Mailing Address - Phone:915-703-6302
Mailing Address - Fax:877-415-8557
Practice Address - Street 1:4532 N MESA ST STE 1A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-6286
Practice Address - Country:US
Practice Address - Phone:915-703-6302
Practice Address - Fax:877-415-8557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX313753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149651Medicaid
2168444OtherPK