Provider Demographics
NPI:1124063649
Name:TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER
Entity type:Organization
Organization Name:TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEAN TX TECH SCHOOL OF PHCY
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KUO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-414-4000
Mailing Address - Street 1:1400 S COULTER ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1786
Mailing Address - Country:US
Mailing Address - Phone:806-414-9390
Mailing Address - Fax:806-356-4625
Practice Address - Street 1:1400 S COULTER ST STE 1100
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1786
Practice Address - Country:US
Practice Address - Phone:806-414-9390
Practice Address - Fax:806-356-4625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
TX213683336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2097324OtherPK
TX145191Medicaid
TX145191Medicaid