Provider Demographics
NPI:1528108826
Name:TEXAS A&M UNIVERSITY SYSTEM HEALTH
Entity type:Organization
Organization Name:TEXAS A&M UNIVERSITY SYSTEM HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:CAROLYN
Authorized Official - Last Name:DANNENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-458-8300
Mailing Address - Street 1:MAIL STOP 1264 - TAMU
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77843-1264
Mailing Address - Country:US
Mailing Address - Phone:979-458-8300
Mailing Address - Fax:
Practice Address - Street 1:311 HOUSTON STREET BLDG 520
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77843-1264
Practice Address - Country:US
Practice Address - Phone:979-458-8300
Practice Address - Fax:979-458-8314
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXAS A&M UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-07
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care