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DSH450018AX UNIVERSITY OF TEXAS MEDICAL BRANCH (Active)
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Main Details
Name
UNIVERSITY OF TEXAS MEDICAL BRANCH
Subdivision Name
UTMB EAR, NOSE & THROAT
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450018AX
Medicare Provider Number
450018
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
3/13/2009
Participating Start Date
4/1/2009
Participating Approval Date
3/13/2009
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
1600 West LEAGUE CITY PARKWAY
SUITE D
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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4/30/09 ADDED SUITE TO ADDR
03/13/2009
June 2025
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