Provider Demographics
NPI:1679605372
Name:TEXAS WOMAN'S UNIVERSITY STUDENT HEALTH SERVICES
Entity type:Organization
Organization Name:TEXAS WOMAN'S UNIVERSITY STUDENT HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MENARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-898-3826
Mailing Address - Street 1:PO BOX 425467
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76204-5467
Mailing Address - Country:US
Mailing Address - Phone:940-898-3826
Mailing Address - Fax:940-898-3844
Practice Address - Street 1:303 ADMINISTRATION DRIVE
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76204-5467
Practice Address - Country:US
Practice Address - Phone:940-898-3826
Practice Address - Fax:940-898-3844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2202208000000X
TX11487261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty