Provider Demographics
NPI:1770944241
Name:TEXAS A&M UNIVERSITY - STUDENT HEALTH SERVICES
Entity type:Organization
Organization Name:TEXAS A&M UNIVERSITY - STUDENT HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR OF HEALTH CENTER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANNENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-458-8300
Mailing Address - Street 1:1264 TAMU
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77843-1264
Mailing Address - Country:US
Mailing Address - Phone:979-458-8300
Mailing Address - Fax:979-458-8313
Practice Address - Street 1:1264 TAMU
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77843-1264
Practice Address - Country:US
Practice Address - Phone:979-458-8300
Practice Address - Fax:979-458-8319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130206363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty