Provider Demographics
NPI:1720098700
Name:MT WEST HEALTH CENTER PA
Entity type:Organization
Organization Name:MT WEST HEALTH CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:VILLALOBOS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:915-584-7920
Mailing Address - Street 1:PO BOX 13203
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79913-3203
Mailing Address - Country:US
Mailing Address - Phone:915-217-2793
Mailing Address - Fax:915-584-8546
Practice Address - Street 1:6151 DEW DR STE 410
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3912
Practice Address - Country:US
Practice Address - Phone:915-584-8124
Practice Address - Fax:915-584-8546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX079714401Medicaid
TX079714401Medicaid