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Organization
TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER
Active
Organization
TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER
Active
Other names
Texa Tech UHSC Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN M. WAGNER (MANAGING DIRECTOR)
(915) 545-6664
Entity
Organization
Contact information
Practice address
9849 KENWORTHY ST, EL PASO, TX 79924-4402
(915) 757-2581
(915) 545-9799
Mailing address
PO BOX 9520, EL PASO, TX 79995-9520
(915) 545-6664
(915) 545-9799
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207QA0505X
Adult Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
084597601
—
TX
Enumeration date
05/11/2007
Last updated
11/04/2008
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