Provider Demographics
NPI:1245282300
Name:MIDWESTERN STATE UNIVERSITY-VINSON HEALTH CENTER
Entity type:Organization
Organization Name:MIDWESTERN STATE UNIVERSITY-VINSON HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, STUDENT HEALTH SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOOMER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:940-397-4604
Mailing Address - Street 1:3410 TAFT BLVD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2095
Mailing Address - Country:US
Mailing Address - Phone:940-397-4604
Mailing Address - Fax:940-397-4504
Practice Address - Street 1:3410 TAFT BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2095
Practice Address - Country:US
Practice Address - Phone:940-397-4604
Practice Address - Fax:940-397-4504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty