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DSH450018AT UNIVERSITY OF TEXAS MEDICAL BRANCH (Terminated)
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Main Details
Name
UNIVERSITY OF TEXAS MEDICAL BRANCH
Subdivision Name
UTMB MEDICAL SPECIALTIES FRIENDSWOOD - ENDOCRINOLOGY & RHEUMATOLOGY CLINIC
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450018AT
Medicare Provider Number
450018
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
3/13/2009
Participating Start Date
4/1/2009
Participating Approval Date
3/13/2009
Last Recertification Date
9/8/2015
Termination Date
Termination Reason
10/1/2016
Site closure
Contacts
Authorizing Official
UTMB
Carolee A. King, Senior Vice President & General Counsel
(409) 772-1904
Primary Contact
NURTAY URDABAYEV, SR BUSINESS MANAGER, CLINICS ADMIN & SUPPORT
(409) 747-3507
Addresses
Street Address
121 W. PARKWOOD
SUITE 121
FRIENDSWOOD, TX 77546
Billing Address
UTMB
301 UNIVERSITY BLVD
JSA 8.136 ATTN: OLGA RODRIGUEZ
GALVESTON, TX 77555-0510
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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