Sun City Sports Medicine and Family Clinic, PA
NPI 1114289956ActiveOrganization· Family Medicine, Sports Medicine· El Paso, TX
Family Medicine, Sports Medicine in El Paso, Texas, registered in NPPES in June 2012. The authorized official on file is Mauro Provencio, Md/Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1114289956 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jun 7, 2012 |
| Last updated in NPPES | Jun 18, 2024 |
| Certified by provider | Jun 18, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Family Medicine, Sports Medicine Primary | 207QS0010X | P1809 | TX |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (TX) |
|---|
Other Family Medicine, Sports Medicine providers in El Paso
- 1801058177
- 1841424181
- 1134513229
- 1194354217
- 1437847753
- 1770047474
- 1063777019
- 1083353197
- 1861165706
- 1962033498