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DSH450018BT UNIVERSITY OF TEXAS MEDICAL BRANCH (Active)
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Main Details
Name
UNIVERSITY OF TEXAS MEDICAL BRANCH
Subdivision Name
UTMB HEALTH FAMILY MEDICINE DICKINSON
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450018BT
Medicare Provider Number
450018
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
5/25/2011
Participating Start Date
7/1/2011
Participating Approval Date
6/27/2011
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
2401 WEST FM 646
SUITE C
DICKINSON, TX 77539
Billing Address
UTMB
301 UNIVERSITY BLVD
Route 0510
GALVESTON, TX 77555
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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8/27/12 UTMB’s Geriatric & Specialty Care Clinic -DSH450018AW has merged with UTMB Dickinson Family Health Clinic -DSH450018BT and relocated to 2401 W. FM 646, Suite C, Dickinson, TX 77539 effective 07/30/2012 . The new clinic name (for the merged clinics) is UTMB Health Family Medicine Dickinson Clinic and it is registered as DSH450018BT.
08/27/2012
April 2025
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