Provider Demographics
NPI:1497879209
Name:UT PHYSICIANS
Entity Type:Organization
Organization Name:UT PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROF. OF MEDICINE & VP FOR BIOTECHN
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:WARD
Authorized Official - Last Name:CASSCELLS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:713-500-3581
Mailing Address - Street 1:7000 FANNIN ST
Mailing Address - Street 2:UCT 795
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-5400
Mailing Address - Country:US
Mailing Address - Phone:713-500-3581
Mailing Address - Fax:713-500-0367
Practice Address - Street 1:6410 FANNIN ST
Practice Address - Street 2:SUITE 600
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3000
Practice Address - Country:US
Practice Address - Phone:832-325-7211
Practice Address - Fax:713-512-2245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5276261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC21905Medicare UPIN