COUNTRY CLUB MEDICAL CENTER LLC (NPI# 1508269523) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508269523 |
| Entity Type | Organization |
| Organization Name | COUNTRY CLUB MEDICAL CENTER LLC |
| Practice Address |
8041 N Mesa St Suite B-2 El Paso TX 79932-1735 |
| Practice Telephone | 9154742454 |
| Practice Fax Number | 9152228895 |
| Mailing Telephone | 9154742454 |
| Mailing Fax Number | 9152228895 |
| Enumeration Date | 2014-10-04 |
| Last Update Date | 2014-12-12 |
| Authorized Official Name | TRACY EDWARD SHORT (OWNER) |
| Authorized Official Telephone | 9154742454 |
| Authorized Official Credential | PA-C |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | J0549 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NM | 00825875 | 05 | |
| TX | MEDICARE ID - TYPE UNSPECIFIED | 8A3569 | 01 |
| NM | 40379761 | 05 | |
| TX | 218658701 | 05 |
| Street Address |
8041 N MESA ST SUITE B-2 |
| City | EL PASO |
| State | TX |
| Zip Code | 79932-1735 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477954683 | Country Club Urgent Care Center LLC | Clinic/Center | 8041 N Mesa St, Suite B-2, El Paso, TX 79932-1735 | 2014-09-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659932267 | Rio Grande Pharmacy, LLC | Pharmacy | 5500 Doniphan Dr. Ste 201-202, El Paso, TX 79932 | 2019-06-25 |
| 1730676461 | Cvs Pharmacy, Inc. | Durable Medical Equipment & Medical Supplies | 8041 N Mesa St # A, El Paso, TX 79932 | 2018-04-18 |
| 1134616063 | Barbara Jin Yoon | Nurse Practitioner | 8041 N Mesa St Ste B3, El Paso, TX 79932 | 2018-04-17 |
| 1225540370 | Epmed, Pa | Durable Medical Equipment & Medical Supplies | 7825 N. Mesa St., El Paso, TX 79932 | 2017-10-30 |
| 1386187995 | Nec El Paso Upper Valley Emergency Center, Lp | Clinic/Center | 7860 N Mesa St, El Paso, TX 79932 | 2016-11-30 |
| 1356708028 | Monica Fabiola Delgado | Health Educator | 740 Country Club Rd, El Paso, TX 79932 | 2016-01-26 |
| 1558736504 | Laura Castillo Cole | Nurse Practitioner | 5021 Crossroads Drive, El Paso, TX 79932 | 2015-12-02 |
| 1942644224 | Jessica Marie Rymer | Pediatrics | 181 Gus Rallis Dr, El Paso, TX 79932 | 2013-04-17 |
| 1053670323 | Gwendolyn N. Facison | Contractor | 732 Elmwood Ct B, El Paso, TX 79932 | 2012-05-08 |
| 1063780518 | Stacey S Grajeda | Pharmacist | 8050 N Mesa, Walgreens, El Paso, TX 79932 | 2011-12-12 |
| Find all providers in zip 79932 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851852297 | Trinity Heritage Pllc | Internal Medicine | 2204 Joe Battle Blvd # D203, El Paso, TX 79938-4660 | 2019-03-28 |
| 1770048175 | Pablo Casares Md Pa | Internal Medicine | 1516 Lomaland Dr, El Paso, TX 79935-4202 | 2019-02-10 |
| 1922504588 | Spectrum Radiologists Services Inc | Internal Medicine | 4855 N Mesa St Ste 130, El Paso, TX 79912-5939 | 2018-04-03 |
| 1831612738 | Cinu Integrated Medical Pa, Pllc | Internal Medicine | 1556 Lomaland Dr Ste 101b, El Paso, TX 79935-4202 | 2017-07-23 |
| 1619490133 | Dwayne Friday, M.d., Pllc | Internal Medicine | 811 Chelsea St Ste B, El Paso, TX 79903-4925 | 2017-07-18 |
| 1376907576 | Rene Roberts Jr. | Internal Medicine | 400 Stewart Dr, El Paso, TX 79915-2530 | 2016-04-13 |
| 1891159349 | Roberto Gonzalez | Internal Medicine | 2311 N Mesa St Ste J, El Paso, TX 79902-3575 | 2016-04-11 |
| 1548643216 | Internal Medicine Providers of El Paso Pllc | Internal Medicine | 717 Lakeway Dr, El Paso, TX 79932-3120 | 2015-06-30 |
| 1326445347 | Mojgan Kaveh-talley | Internal Medicine | 5100 North Piedras Street, El Paso, TX 79930 | 2014-11-20 |
| 1699183848 | Nathaniel Griffith, Do Pa | Internal Medicine | 10701 Sam Snead Dr, El Paso, TX 79935-2413 | 2014-07-31 |
| Find all providers in EL PASO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.