MEDICARE: AGGIELAND ADHD 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	261QP2300X	Primary Care Clinic/Center	H9144	TX

General Provider Information

NPI Number	:	1558743609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGGIELAND ADHD CENTER

Provider Business Mailing Address
First Line	:	2310 DE LEE ST STE 200
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77802-2815
Country	:	US
Telephone Number	:	979-774-0866
Fax Number	:

Provider Business Practice Location Address
First Line	:	2310 DE LEE ST STE 200
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77802-2815
Country	:	US
Telephone Number	:	979-774-0866
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL RUGGIERO
Credential	:	DO
Telephone Number	:	979-774-0866

Provider Enumeration Date	:	06/25/2015
Last Update Date	:	06/25/2015

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