Provider Demographics
NPI:1700898681
Name:UNIVERSITY OF TEXAS HEALTH SCIENCE
Entity Type:Organization
Organization Name:UNIVERSITY OF TEXAS HEALTH SCIENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:MACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, NPC
Authorized Official - Phone:713-500-3267
Mailing Address - Street 1:7000 FANNIN ST
Mailing Address - Street 2:STE. 1620
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-5400
Mailing Address - Country:US
Mailing Address - Phone:713-500-3267
Mailing Address - Fax:713-500-3263
Practice Address - Street 1:7000 FANNIN ST
Practice Address - Street 2:STE. 1620
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-5400
Practice Address - Country:US
Practice Address - Phone:713-500-3267
Practice Address - Fax:713-500-3263
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER OF HOUSTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-12
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0035AEOtherBCBS GROUP #
TX0035AEMedicare ID - Type UnspecifiedGROUP MEDICARE NUMBER