Provider Demographics
NPI:1386923670
Name:UTMB
Entity type:Organization
Organization Name:UTMB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:CALLENDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-772-1902
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:JSA 9.128. DEPT OF NEUROLOGY
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0539
Mailing Address - Country:US
Mailing Address - Phone:409-772-2646
Mailing Address - Fax:409-772-6940
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:JSA 9.128. DEPT OF NEUROLOGY
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0539
Practice Address - Country:US
Practice Address - Phone:409-772-2646
Practice Address - Fax:409-772-6940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-04
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10040916281P00000X
TX282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital
No282N00000XHospitalsGeneral Acute Care Hospital