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DSH450018AI UNIVERSITY OF TEXAS MEDICAL BRANCH (Active)
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Main Details
Name
UNIVERSITY OF TEXAS MEDICAL BRANCH
Subdivision Name
UTMB CBC Alvin Primary & Specialty Care
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450018AI
Medicare Provider Number
450018
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
11/27/2007
Participating Start Date
1/1/2008
Participating Approval Date
12/1/2007
Last Recertification Date
8/20/2024
Contacts
Authorizing Official
UTMB
Carolanda B Woodgett, Senior Vice President and Chief Legal Officer
(409) 747-8735
Primary Contact
UTMB
Sharon Chapman, Director of Operations
(409) 747-3509
Addresses
Street Address
2020 EAST HIGHWAY 6
ALVIN, TX 77511
Billing Address
UTMB
301 UNIVERSITY BLVD
Route 0510
GALVESTON, TX 77555
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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2/7/08 ADDED MED #
02/07/2008
3/23/12 Added NPI#; 2/7/08 ADDED MED #
11/27/2007
April 2025
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