Provider Demographics
NPI:1699014779
Name:SOUTHWESTERN UNIVERSITY
Entity Type:Organization
Organization Name:SOUTHWESTERN UNIVERSITY
Other - Org Name:SOUTHWESTERN UNIVERSITY HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FOR FISCAL AFFAIRS
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-863-1475
Mailing Address - Street 1:1001 E UNIVERSITY AVE
Mailing Address - Street 2:PROTHRO CENTER, SUITE 200
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-6100
Mailing Address - Country:US
Mailing Address - Phone:512-863-1252
Mailing Address - Fax:512-863-1814
Practice Address - Street 1:1001 E UNIVERSITY AVE
Practice Address - Street 2:PROTHRO CENTER, SUITE 200
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-6100
Practice Address - Country:US
Practice Address - Phone:512-863-1252
Practice Address - Fax:512-863-1814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health