Healthcare Provider Details

I. General information

NPI: 1083167134
Provider Name (Legal Business Name): TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 07/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 B TRANSMOUNTAIN ROAD
EL PASO TX
79911
US

IV. Provider business mailing address

4800 ALBERTA AVE 101
EL PASO TX
79905
US

V. Phone/Fax

Practice location:
  • Phone: 915-215-5626
  • Fax: 915-545-6984
Mailing address:
  • Phone: 915-215-4478
  • Fax: 915-545-5755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVEN MARC WAGNER
Title or Position: MANAGING DIRECTOR
Credential: PH.D. M.P.A.
Phone: 915-215-4478