1548389554 NPI number — TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER EL PASO

Table of content: (NPI 1548389554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548389554 NPI number — TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER EL PASO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER 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:
TEXAS TECH UHSC NEUROLOGY DEPT.
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:
1548389554
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9520
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79995-9520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-545-6664
Provider Business Mailing Address Fax Number:
915-545-9799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4615 ALAMEDA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79905-2702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-545-6830
Provider Business Practice Location Address Fax Number:
915-545-9799
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FUCIARELLI
Authorized Official First Name:
SUE
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT FOR FINANCE AND ADMI
Authorized Official Telephone Number:
915-215-4300

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0008X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084A2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084D0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084N0402X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084V0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 084595001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: CC8142 . This is a "RAILROAD MEDICARE GROUP #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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