Provider Demographics
NPI: | 1003824038 |
---|---|
Name: | TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER EL PASO |
Entity Type: | Organization |
Organization Name: | TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER EL PASO |
Other - Org Name: | TEXAS TECH UNIVERSITY HEALTH SCIENCES |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | VICE PRESIDENT FOR FINANCE AND ADMI |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SUE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | FUCIARELLI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 915-215-4300 |
Mailing Address - Street 1: | PO BOX 9520 |
Mailing Address - Street 2: | |
Mailing Address - City: | EL PASO |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 79995-9520 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 915-545-9795 |
Mailing Address - Fax: | 915-545-9799 |
Practice Address - Street 1: | 4801 ALBERTA AVE. |
Practice Address - Street 2: | |
Practice Address - City: | EL PASO |
Practice Address - State: | TX |
Practice Address - Zip Code: | 79905 |
Practice Address - Country: | US |
Practice Address - Phone: | 915-545-7579 |
Practice Address - Fax: | 915-545-8870 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-08-04 |
Last Update Date: | 2022-04-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
No | 183500000X | Pharmacy Service Providers | Pharmacist | Group - Multi-Specialty | |
No | 207SG0201X | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Genetics (M.D.) | Group - Multi-Specialty |
No | 2080A0000X | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine | Group - Multi-Specialty |
No | 2080N0001X | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine | Group - Multi-Specialty |
No | 2080P0201X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Allergy/Immunology | Group - Multi-Specialty |
No | 2080P0202X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | Group - Multi-Specialty |
No | 2080P0203X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine | Group - Multi-Specialty |
No | 2080P0205X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology | Group - Multi-Specialty |
No | 2080P0207X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology | Group - Multi-Specialty |
No | 2080P0208X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Infectious Diseases | Group - Multi-Specialty |
No | 2080P0214X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology | Group - Multi-Specialty |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 140114313 | Other | CSHCN GROUP NUMBER |
TX | 081651401 | Medicaid | |
TX | CC8142 | Other | RAILROAD MEDICARE GROUP# |
TX | AP59 | Medicare ID - Type Unspecified | GROUP NUMBER |