Provider Demographics
NPI:1194083311
Name:WEST TEXAS A & M UNIVERSITY
Entity type:Organization
Organization Name:WEST TEXAS A & M UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEPARTMENT HEAD
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:F
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:806-651-5108
Mailing Address - Street 1:WTAMU BOX 60757
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79016-0001
Mailing Address - Country:US
Mailing Address - Phone:806-651-5108
Mailing Address - Fax:806-651-5105
Practice Address - Street 1:2501 4TH AVE
Practice Address - Street 2:
Practice Address - City:CANYON
Practice Address - State:TX
Practice Address - Zip Code:79016-0001
Practice Address - Country:US
Practice Address - Phone:806-651-5108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech