Provider Demographics
NPI:1538381207
Name:TEXAS CHRISTIAN UNIVERSITY
Entity type:Organization
Organization Name:TEXAS CHRISTIAN UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE CHANCELLOR FOR FINANCE AND ADM
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-257-7815
Mailing Address - Street 1:BOX 297400
Mailing Address - Street 2:TEXAS CHRISTIAN UNIVERSITY BROWN LUPTON HEALTH CENTER
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76129
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2825 STADIUM DRIVE
Practice Address - Street 2:BROWN LUPTON HEALTH CENTER
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109
Practice Address - Country:US
Practice Address - Phone:817-257-7940
Practice Address - Fax:817-257-7279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health