1497711477 NPI number — THE UNIVERSITY OF TEXAS MEDICAL BRANCH

Table of content: (NPI 1497711477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497711477 NPI number — THE UNIVERSITY OF TEXAS MEDICAL BRANCH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE UNIVERSITY OF TEXAS MEDICAL BRANCH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497711477
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 UNIVERSITY BLVD
Provider Second Line Business Mailing Address:
REBECCA SEALY HOSPITAL, ROOM 4.232
Provider Business Mailing Address City Name:
GALVESTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77555-5302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-747-8779
Provider Business Mailing Address Fax Number:
409-747-8775

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GALVESTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77555-5302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-747-9734
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CALLENDER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
409-772-1902

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HH3051 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 021759801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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