# FEDERAL PRISON CAMP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992061188
- **Authorized official:** MS. KATHLEEN L RIVERS RN (HEALTH SERVICES ADMINISTRATOR)
- **Authorized official phone:** (979) 823-1879

## Contact information

- **Practice address:** 1100 URSULINE AVE, BRYAN, TX 77803-4951
- **Practice address phone:** (979) 823-1879
- **Practice address fax:** (979) 821-3315
- **Mailing address:** 1100 URSULINE AVE, BRYAN, TX 77805-2197
- **Mailing address phone:** (979) 823-1879
- **Mailing address fax:** (979) 821-3315

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2400X | Prison Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 04/02/2012
- **Last updated:** 04/02/2012