Provider Demographics
NPI:1841489622
Name:EL PASO RADIATION MEDICINE, P.A.
Entity type:Organization
Organization Name:EL PASO RADIATION MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:ELKIN
Authorized Official - Last Name:ELLERIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-685-0114
Mailing Address - Street 1:224 COBBLE CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-1838
Mailing Address - Country:US
Mailing Address - Phone:856-685-0114
Mailing Address - Fax:
Practice Address - Street 1:1401 W EXPRESSWAY 83
Practice Address - Street 2:SAN BENITO CANCER CENTER
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-7770
Practice Address - Country:US
Practice Address - Phone:856-685-0114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL86792085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z153OtherMEDICARE PTAN