Provider Demographics
NPI:1497711477
Name:THE UNIVERSITY OF TEXAS MEDICAL BRANCH
Entity Type:Organization
Organization Name:THE UNIVERSITY OF TEXAS MEDICAL BRANCH
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:REBECCA SEALY HOSPITAL, ROOM 4.232
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-5302
Mailing Address - Country:US
Mailing Address - Phone:409-747-8779
Mailing Address - Fax:409-747-8775
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-5302
Practice Address - Country:US
Practice Address - Phone:409-747-9734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH3051OtherBLUE CROSS BLUE SHIELD
TX021759801Medicaid
TX021759801Medicaid