Provider Demographics
NPI:1528244068
Name:WENDY D. PHIPPS, MD, PA
Entity type:Organization
Organization Name:WENDY D. PHIPPS, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:D
Authorized Official - Last Name:PHIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-544-9700
Mailing Address - Street 1:401 BOSTON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2601
Mailing Address - Country:US
Mailing Address - Phone:915-544-9700
Mailing Address - Fax:915-544-9701
Practice Address - Street 1:401 BOSTON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2601
Practice Address - Country:US
Practice Address - Phone:915-544-9700
Practice Address - Fax:915-544-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4648261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165329703Medicaid
TXH64785Medicare UPIN
TX00966WMedicare PIN