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DSH450018CA UNIVERSITY OF TEXAS MEDICAL BRANCH (Active)
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Main Details
Name
UNIVERSITY OF TEXAS MEDICAL BRANCH
Subdivision Name
UTMB VLTC Dermatology Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450018CA
Medicare Provider Number
450018
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
2/24/2012
Participating Start Date
4/1/2012
Participating Approval Date
3/28/2012
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 A
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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