1013942150 NPI number — TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER AMARILLO

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 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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