1548219827 NPI number — TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER LUBBOCK

Table of content: (NPI 1548219827)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548219827 NPI number — TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER LUBBOCK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER LUBBOCK
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:
TTUHSC- DERMATOLOGY
Provider Other Organization Name Type Code:
3
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:
1548219827
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 27476
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84127-0476
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-743-4263
Provider Business Mailing Address Fax Number:
806-743-2787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3601 4TH ST
Provider Second Line Business Practice Location Address:
STE 4A100
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79430-0002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-743-1842
Provider Business Practice Location Address Fax Number:
806-743-1105
Provider Enumeration Date:
05/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MAJORS
Authorized Official First Name:
BRENT
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTANT DEAN FINANCE ADMIN
Authorized Official Telephone Number:
806-743-1830

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207ND0900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00QQ84 . This is a "BC/BS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 084590101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: G1217 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 140327105 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: CD9207 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 100708740A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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