| Socorro Medical Clinic Llc | |
|
10720 N Loop Dr Suite A Socorro TX 79927-4409 | |
| (915) 351-4010 | |
| (915) 309-1816 |
| Full Name | Socorro Medical Clinic Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 10720 N Loop Dr, Socorro, Texas |
| Authorized Official Name and Position | Adekunle Adedayo Adedeji (PRESIDENT) |
| Authorized Official Contact | 9153514010 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Socorro Medical Clinic Llc Po Box 221287 El Paso TX 79913-4287 Ph: (915) 351-4010 | Socorro Medical Clinic Llc 10720 N Loop Dr Suite A Socorro TX 79927-4409 Ph: (915) 351-4010 |
| NPI Number | 1922478114 |
|---|---|
| Provider Enumeration Date | 09/30/2015 |
| Last Update Date | 09/30/2015 |
| Medicare PECOS PAC ID | 3577862093 |
|---|---|
| Medicare Enrollment ID | O20160504000769 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922478114 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | N3416 (Texas) | Primary |
| Provider Name | Adekunle Adedeji |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902086937 PECOS PAC ID: 4486791753 Enrollment ID: I20091020000378 |
| Provider Name | Olufemi Ayobami Aduroja |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1366762874 PECOS PAC ID: 6608090006 Enrollment ID: I20180614002770 |
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