Provider Demographics
NPI:1548286651
Name:MITCHELL J FARRELL MD PA
Entity type:Organization
Organization Name:MITCHELL J FARRELL MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-921-7600
Mailing Address - Street 1:1400 GEORGE DIETER DR
Mailing Address - Street 2:#100
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7601
Mailing Address - Country:US
Mailing Address - Phone:915-921-7600
Mailing Address - Fax:
Practice Address - Street 1:1416 GEORGE DIETER DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7601
Practice Address - Country:US
Practice Address - Phone:915-598-4240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCN8855Medicare PIN
TX0048BYMedicare ID - Type Unspecified