Healthcare Provider Details

I. General information

NPI: 1679605372
Provider Name (Legal Business Name): TEXAS WOMAN'S UNIVERSITY STUDENT HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 ADMINISTRATION DRIVE
DENTON TX
76204-5467
US

IV. Provider business mailing address

PO BOX 425467
DENTON TX
76204-5467
US

V. Phone/Fax

Practice location:
  • Phone: 940-898-3826
  • Fax: 940-898-3844
Mailing address:
  • Phone: 940-898-3826
  • Fax: 940-898-3844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberJ2202
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number11487
License Number StateTX

VIII. Authorized Official

Name: DR. CONSTANCE MENARD
Title or Position: DIRECTOR
Credential: M.D.
Phone: 940-898-3826