Provider Demographics
NPI:1457652323
Name:UNIVERSITY OF TEXAS DALLAS
Entity Type:Organization
Organization Name:UNIVERSITY OF TEXAS DALLAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD ATHLETIC TRAINER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:MONAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:ATC
Authorized Official - Phone:972-883-4066
Mailing Address - Street 1:800 W CAMPBELL RD
Mailing Address - Street 2:AB10
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3021
Mailing Address - Country:US
Mailing Address - Phone:972-883-4066
Mailing Address - Fax:972-883-4496
Practice Address - Street 1:800 W CAMPBELL RD
Practice Address - Street 2:AB10
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3021
Practice Address - Country:US
Practice Address - Phone:972-883-4066
Practice Address - Fax:972-883-4496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health