Provider Demographics
NPI:1033310388
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:PROGRAM MANAGER, RESIDENCY TRAINING
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PANDANELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-772-4194
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:417 JENNIE SEALY HOSPITAL
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0462
Mailing Address - Country:US
Mailing Address - Phone:409-772-4194
Mailing Address - Fax:409-772-9785
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:417 JENNIE SEALY HOSPITAL
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0462
Practice Address - Country:US
Practice Address - Phone:409-772-4194
Practice Address - Fax:409-772-9785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local