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General NPI Number Information
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NPI Number | 1710030366
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Entity Type | Organization
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Legal Business Name | TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER AT AMARILLO
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1400 S COULTER ST
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City | AMARILLO
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State | TX
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Zip | 79106-1786
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Country | US
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Telephone | 806-354-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 WALLACE BLVD
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City | AMARILLO
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State | TX
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Zip | 79106-1708
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Country | US
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Telephone | 806-354-5700
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | MRS. DENISE RUSSELL
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Credential | CPCS
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Telephone | 806-354-5495
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | R05258
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | R05258
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License Number State | TX
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