1013942150 NPI number — TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER AMARILLO

Table of content: (NPI 1013942150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013942150 NPI number — TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER AMARILLO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER AMARILLO
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:
TEXAS TECH UHSC FAMILY MEDICINE
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:
1013942150
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 S COULTER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79106-1786
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-414-9562
Provider Business Mailing Address Fax Number:
806-356-4673

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 S COULTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79106-1786
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-414-9559
Provider Business Practice Location Address Fax Number:
806-351-3765
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
UNIT MANAGER
Authorized Official Telephone Number:
806-414-9565

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 112119601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: G4070 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100759180B , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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