Healthcare Provider Details

I. General information

NPI: 1689805186
Provider Name (Legal Business Name): TEXAS TECH UNIVERSITY HEALTH SCIENCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 07/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 ALBERTA AVE
EL PASO TX
79905-2709
US

IV. Provider business mailing address

4800 ALBERTA AVE
EL PASO TX
79905-2709
US

V. Phone/Fax

Practice location:
  • Phone: 915-545-8826
  • Fax: 915-545-6975
Mailing address:
  • Phone: 915-545-8826
  • Fax: 915-545-6975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number390200000X
License Number StateTX

VIII. Authorized Official

Name: SASTRU CHAMARTHI
Title or Position: M.D.
Credential:
Phone: 915-545-8826