1447412614 NPI number — TEXAS TECH UNIVERSITY EL PASO

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 1447412614 NPI number — TEXAS TECH UNIVERSITY EL PASO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS TECH UNIVERSITY EL PASO
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:
1447412614
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2008
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:
DEPT OF PEDIATRICS
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79905-2709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-569-1445
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4800 ALBERTA AVE
Provider Second Line Business Practice Location Address:
DEPT OF PEDIATRICS
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79905-2709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-545-6785
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/30/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WAGNER
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
MANAGING DIRECTOR
Authorized Official Telephone Number:
915-783-8164

Provider Taxonomy Codes

  • Taxonomy code: 282NC2000X , with the licence number:  BP10031878 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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