Organization
EL PASO PHYSICIAN GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLAY M. HEIGHTEN M.D. (PRESIDENT)
(972) 739-3001
Entity
Organization
Contact information
Practice address
1626 MEDICAL CENTER DR, 5TH FLOOR, SUITE 503, EL PASO, TX 79902-5010
(915) 546-9200
(915) 546-9800
Mailing address
9229 LBJ FWY, SUITE 250, DALLAS, TX 75243-3405
(972) 739-3097
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
133V00000X
Registered Dietitian
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
208600000X
Surgery Physician
—
—
225100000X
Physical Therapist
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0042KP
BCBS
TX
05
—
162360501
—
TX
05
—
162360502
—
TX
05
—
162360503
—
TX
05
—
98535331
—
NM
Enumeration date
05/12/2006
Last updated
06/10/2008
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