Provider Demographics
NPI:1770673113
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:ASSOCIATE REGIONAL DEAN
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:FINICAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-335-5115
Mailing Address - Street 1:701 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79763-4206
Mailing Address - Country:US
Mailing Address - Phone:432-335-1421
Mailing Address - Fax:432-335-1807
Practice Address - Street 1:1701 N LOOP 250 W
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-6002
Practice Address - Country:US
Practice Address - Phone:432-683-3250
Practice Address - Fax:432-522-7287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0047BDMedicare ID - Type UnspecifiedMEDICARE GROUP NO.