Basic Information
| Provider Information | |||||||||
| NPI: | 1790095362 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UNTHSC | ||||||||
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| OtherOrganizationName: | UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3500 CAMP BOWIE BLVD | ||||||||
| Address2: | |||||||||
| City: | FT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761072644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177352000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3500 CAMP BOWIE BLVD | ||||||||
| Address2: | |||||||||
| City: | FT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177352000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2010 | ||||||||
| LastUpdateDate: | 06/08/2018 | ||||||||
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| AuthorizedOfficialLastName: | HENDERSON | ||||||||
| AuthorizedOfficialFirstName: | LESLIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | REVENUE CYCLE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8177352008 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.