Provider Demographics
NPI:1790948297
Name:TEXAS TECH UNIVERSITY HSC
Entity Type:Organization
Organization Name:TEXAS TECH UNIVERSITY HSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MPIP MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-545-6664
Mailing Address - Street 1:1020 S MESA HILLS DR APT 5112
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5121
Mailing Address - Country:US
Mailing Address - Phone:915-760-5918
Mailing Address - Fax:
Practice Address - Street 1:4800 ALBERTA AVE # B3200
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2709
Practice Address - Country:US
Practice Address - Phone:915-545-7333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital