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DSH450018K UNIVERSITY OF TEXAS MEDICAL BRANCH (Active)
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Main Details
Name
UNIVERSITY OF TEXAS MEDICAL BRANCH
Subdivision Name
UTMB VLTC Internal Medicine Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450018K
Medicare Provider Number
450018
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
11/29/2007
Participating Start Date
12/15/2005
Participating Approval Date
11/29/2007
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
2660 GULF FREEWAY SOUTH
ENTRANCE B
LEAGUE CITY, TX 77573
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 MODIF MED # (WAS 109372601)
11/29/2007
June 2025
June 2025
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