MEDICARE: TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1548250137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER

Provider Business Mailing Address
First Line	:	701 WEST 5TH ST.
Second Line	:
City	:	ODESSA
State	:	TX
Zip	:	79763-4368
Country	:	US
Telephone Number	:	432-335-5120
Fax Number	:	432-335-5128

Provider Business Practice Location Address
First Line	:	701 WEST 5TH ST.
Second Line	:
City	:	ODESSA
State	:	TX
Zip	:	79763-4368
Country	:	US
Telephone Number	:	432-335-5120
Fax Number	:	432-335-5128

Authorized Official
Title or Position	:	ASSOCIATE REGIONAL DEAN
Name	:	MR. WILLIAM D. FINICAL
Credential	:
Telephone Number	:	432-335-5113

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	08/22/2020

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