Basic Information
| Provider Information | |||||||||
| NPI: | 1689682841 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOUGHTON COLLEGE STUDENT HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5199 | ||||||||
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| City: | ABILENE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 796085199 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668906390 | ||||||||
| FaxNumber: | 3254378390 | ||||||||
| Practice Location | |||||||||
| Address1: | 9789 CR 35 | ||||||||
| Address2: | |||||||||
| City: | HOUGHTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5855679483 | ||||||||
| FaxNumber: | 5855674303 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 11/05/2007 | ||||||||
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| AuthorizedOfficialLastName: | BRUBAKER | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 5855679483 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.