Provider Demographics
NPI:1770541435
Name:WEST TEXAS PROVIDER SERVICES LLC
Entity type:Organization
Organization Name:WEST TEXAS PROVIDER SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:D
Authorized Official - Last Name:PENDERGRAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-581-6644
Mailing Address - Street 1:200 BARTLETT DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1628
Mailing Address - Country:US
Mailing Address - Phone:915-581-7960
Mailing Address - Fax:915-584-7599
Practice Address - Street 1:200 BARTLETT DR
Practice Address - Street 2:SUITE 108
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-1628
Practice Address - Country:US
Practice Address - Phone:915-581-7960
Practice Address - Fax:915-584-7599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33BP3500X332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4720080001Medicare NSC