1629465950 NPI number — UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON

Table of content: ELIZABETH MCELREATH MUSGRAVE MD (NPI 1902845803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629465950 NPI number — UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON
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:
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Provider Other Name Prefix Text:
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NPI Number Information

NPI Number:
1629465950
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11437 OUTPOST COVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77318-5485
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-890-3287
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11437 OUTPOST COVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77318-5485
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-890-3287
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/24/2015

Additional Information

Authorized Official

Authorized Official Last Name:
VINCENT
Authorized Official First Name:
BOBBY
Authorized Official Middle Name:
Authorized Official Title or Position:
REGIONAL MEDICAL DIRECTOR
Authorized Official Telephone Number:
936-295-8200

Provider Taxonomy Codes

  • Taxonomy code: 305S00000X , with the licence number:  PA 00006 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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