Provider Demographics
NPI:1942506886
Name:UTMB REGIONAL MATERNAL AND CHILD HEALTH PROGRAM
Entity Type:Organization
Organization Name:UTMB REGIONAL MATERNAL AND CHILD HEALTH PROGRAM
Other - Org Name:UTMB-NEWCANEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, CLINICAL SUPPORT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-772-7725
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:ROUTE-1078
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-1078
Mailing Address - Country:US
Mailing Address - Phone:409-772-7725
Mailing Address - Fax:409-772-7726
Practice Address - Street 1:21134 I U.S. HWY 59
Practice Address - Street 2:
Practice Address - City:NEW CANEY
Practice Address - State:TX
Practice Address - Zip Code:77357-8290
Practice Address - Country:US
Practice Address - Phone:281-577-8966
Practice Address - Fax:281-577-8991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138740923Medicaid