Provider Demographics
NPI:1962518035
Name:EDWARD R ASSI DO PA
Entity type:Organization
Organization Name:EDWARD R ASSI DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-577-9009
Mailing Address - Street 1:1700 E CLIFF DR BLDG A
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5192
Mailing Address - Country:US
Mailing Address - Phone:915-577-9009
Mailing Address - Fax:915-577-9006
Practice Address - Street 1:1700 E CLIFF DR BLDG A
Practice Address - Street 2:SUITE 200
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5192
Practice Address - Country:US
Practice Address - Phone:915-577-9009
Practice Address - Fax:915-577-9006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0002KPOtherBLUE CROSS BLUE SHIELD
TX2005662-01Medicaid
TX00492VMedicare PIN