Provider Demographics
NPI:1851918700
Name:TEXAS A&M UNIVERSITY SYSTEM HEALTH SCIENCE CENTER
Entity Type:Organization
Organization Name:TEXAS A&M UNIVERSITY SYSTEM HEALTH SCIENCE CENTER
Other - Org Name:TEXAS A&M UNIVERSITY SCHOOL OF NURSING MOBILE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:SIEGERT
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-436-0398
Mailing Address - Street 1:8441 RIVERSIDE PARKEWAY
Mailing Address - Street 2:MS 1359
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77807
Mailing Address - Country:US
Mailing Address - Phone:979-436-0587
Mailing Address - Fax:
Practice Address - Street 1:8447 RIVERSIDE PKWY # MS 1359
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77807-1552
Practice Address - Country:US
Practice Address - Phone:979-436-0587
Practice Address - Fax:979-436-0046
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXAS A&M UNIVERSITY SYSTEM HEALTH SCIENCE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-26
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty