| Organization Name: | WEST TEXAS A&M UNIVERSITY STUDENT MEDICAL SERVICES |
| NPI Number: | 1407967599 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LUANNE RICKWARTZ (DIRECTOR) |
| Mailing Address: | 2620 N Russel Long Blvd Virgil Henson Activities Center Room 104 Canyon |
| State: | TX US |
| Postal Code: | 790160001 |
| Phone Number: | 8066513287 |
| Fax Number: | 8066513289 |
| NPI Enumeration Date: | 08/31/2006 |
| NPI Last Update Date: | 03/11/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QS1000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Student Health |
| Taxonomy Definition: | |