Provider Demographics
NPI:1962871699
Name:UNIVERSITY OF TEXAS MEDICAL BRANCH
Entity type:Organization
Organization Name:UNIVERSITY OF TEXAS MEDICAL BRANCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-772-7893
Mailing Address - Street 1:304 LAKE FRONT DR
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2820
Mailing Address - Country:US
Mailing Address - Phone:713-562-1478
Mailing Address - Fax:
Practice Address - Street 1:3828 HUGHES CT
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-6244
Practice Address - Country:US
Practice Address - Phone:281-534-2576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCNM2763282NW0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NW0100XHospitalsGeneral Acute Care HospitalWomen