MEDICARE: TEXAS A&M UNIVERSITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center		TX
2	261QP2000X	Physical Therapy Clinic/Center	1165990	TX

General Provider Information

NPI Number	:	1134356231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS A&M UNIVERSITY

Provider Business Mailing Address
First Line	:	PO BOX 30017
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77842-3017
Country	:	US
Telephone Number	:	979-845-3121
Fax Number	:	979-847-8514

Provider Business Practice Location Address
First Line	:	161 WELLBORN RD
Second Line	:	BRIGHT FOOTBALL COMPLEX
City	:	COLLEGE STATION
State	:	TX
Zip	:	77843-0001
Country	:	US
Telephone Number	:	979-845-3121
Fax Number	:	979-847-8514

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MATTHEW SCOTT KEE
Credential	:
Telephone Number	:	979-845-3121

Provider Enumeration Date	:	06/16/2009
Last Update Date	:	11/17/2011

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Directions to “TEXAS A&M UNIVERSITY ” Practice Location

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