1104095470 NPI number — UNIVERSITY OF TEXAS AT AUSTIN

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 1104095470 NPI number — UNIVERSITY OF TEXAS AT AUSTIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF TEXAS AT AUSTIN
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:
UNIVERSITY HEALTH SERVICES
Provider Other Organization Name Type Code:
5
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:
1104095470
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7339
Provider Second Line Business Mailing Address:
UNIVERSITY OF TEXAS AT AUSTIN
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78713-7339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-475-8231
Provider Business Mailing Address Fax Number:
512-471-0680

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 W DEAN KEETON
Provider Second Line Business Practice Location Address:
UNIVERSITY HEALTH SERVICES
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-475-8231
Provider Business Practice Location Address Fax Number:
512-471-0680
Provider Enumeration Date:
02/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CHAMPAGNEMILLER
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
512-475-8231

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com