Organization
TEXAS A&M UNIVERSITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHIL HEDRICK ATC, LAT (ASSISTANT A.D. ATHLETIC TRAINING)
(979) 862-2930
Entity
Organization
Contact information
Practice address
12 JOHN DAVID CROW BLVD, COLLEGE STATION, TX 77843
(979) 845-3121
Mailing address
PO BOX 30017, COLLEGE STATION, TX 77842-3017
Taxonomy
Speciality
Code
Description
License number
State
2083S0010X
Sports Medicine (Preventive Medicine) Physician
Primary
AT5667
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AT5667
ATHLETIC TRAINING
TX
Enumeration date
08/18/2015
Last updated
08/18/2015
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