1083167134 NPI number — TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083167134 NPI number — TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083167134
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4800 ALBERTA AVE
Provider Second Line Business Mailing Address:
101
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-215-4478
Provider Business Mailing Address Fax Number:
915-545-5755

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 B TRANSMOUNTAIN ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-215-5626
Provider Business Practice Location Address Fax Number:
915-545-6984
Provider Enumeration Date:
07/25/2016

Additional Information

Authorized Official

Authorized Official Last Name:
WAGNER
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
MARC
Authorized Official Title or Position:
MANAGING DIRECTOR
Authorized Official Telephone Number:
915-215-4478

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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