Provider Demographics
NPI:1154745651
Name:THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON
Entity type:Organization
Organization Name:THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PATIENT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIEU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-486-4242
Mailing Address - Street 1:7500 CAMBRIDGE ST
Mailing Address - Street 2:SUITE 3510
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2032
Mailing Address - Country:US
Mailing Address - Phone:713-486-4111
Mailing Address - Fax:
Practice Address - Street 1:700 N SAM HOUSTON PKWY W
Practice Address - Street 2:SUITE 140
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77067-4338
Practice Address - Country:US
Practice Address - Phone:832-828-1446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT HOUSTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-05
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223D0001X
TX1223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX349191211Medicaid