Organization
FEDERAL PRISON CAMP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATHLEEN L RIVERS RN (HEALTH SERVICES ADMINISTRATOR)
(979) 823-1879
Entity
Organization
Contact information
Practice address
1100 URSULINE AVE, BRYAN, TX 77803-4951
(979) 823-1879
(979) 821-3315
Mailing address
1100 URSULINE AVE, BRYAN, TX 77805-2197
(979) 823-1879
(979) 821-3315
Taxonomy
Speciality
Code
Description
License number
State
261QP2400X
Prison Health Clinic/Center
Primary
—
—
Other
Enumeration date
04/02/2012
Last updated
04/02/2012
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