1417034455 NPI number — UTMB REGIONAL MATERNAL AND CHILD HEALTH PROGRAM

Table of content: (NPI 1417034455)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417034455 NPI number — UTMB REGIONAL MATERNAL AND CHILD HEALTH PROGRAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UTMB REGIONAL MATERNAL AND CHILD HEALTH PROGRAM
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:
UTMB RMCHP - DICKINSON
Provider Other Organization Name Type Code:
5
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:
1417034455
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
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:
ROUTE - 1078
Provider Business Mailing Address City Name:
GALVESTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77555-1078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-772-7725
Provider Business Mailing Address Fax Number:
409-772-7726

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3828 HUGHES CT
Provider Second Line Business Practice Location Address:
STE. 104
Provider Business Practice Location Address City Name:
DICKINSON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77539-6244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-534-2576
Provider Business Practice Location Address Fax Number:
281-534-4598
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CASTILLO
Authorized Official First Name:
LIZ
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, CLINICAL SUPPORT SERVICES
Authorized Official Telephone Number:
409-772-7725

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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