Provider Demographics
NPI:1992733554
Name:MINIMALLY INVASIVE UROLOGY OF THE SOUTHWEST
Entity type:Organization
Organization Name:MINIMALLY INVASIVE UROLOGY OF THE SOUTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:H
Authorized Official - Last Name:FIERRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-838-1193
Mailing Address - Street 1:1700 N OREGON
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902
Mailing Address - Country:US
Mailing Address - Phone:915-838-1193
Mailing Address - Fax:915-838-1198
Practice Address - Street 1:1700 N OREGON ST
Practice Address - Street 2:STE 560
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3584
Practice Address - Country:US
Practice Address - Phone:915-838-1193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168076101Medicaid
TX168076101Medicaid