Provider Demographics
NPI:1083062731
Name:TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER
Entity Type:Organization
Organization Name:TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSOR PEDIATRIC DEPT, RESEARCH
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:WRIGHT
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, PHD
Authorized Official - Phone:806-414-9578
Mailing Address - Street 1:1400 WALLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1708
Mailing Address - Country:US
Mailing Address - Phone:806-414-9578
Mailing Address - Fax:806-414-9733
Practice Address - Street 1:1400 WALLACE BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1708
Practice Address - Country:US
Practice Address - Phone:806-414-9578
Practice Address - Fax:806-414-9733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17912261QR1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch