Provider Demographics
NPI:1235270463
Name:UNIVERSITY OF TEXAS AT ARLINGTON
Entity Type:Organization
Organization Name:UNIVERSITY OF TEXAS AT ARLINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-272-2771
Mailing Address - Street 1:605 S. WEST STREET
Mailing Address - Street 2:P.O. BOX 19329
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76019-0000
Mailing Address - Country:US
Mailing Address - Phone:817-272-2771
Mailing Address - Fax:817-272-9172
Practice Address - Street 1:605 S. WEST STREET
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76019-0001
Practice Address - Country:US
Practice Address - Phone:817-272-2771
Practice Address - Fax:817-272-7192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health