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DSH450018DM UNIVERSITY OF TEXAS MEDICAL BRANCH (Active)
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Main Details
Name
UNIVERSITY OF TEXAS MEDICAL BRANCH
Subdivision Name
UTMB Pediatrics Primary Care - Lake Jackson
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH450018DM
Medicare Provider Number
450018
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/7/2016
Participating Start Date
7/1/2016
Participating Approval Date
5/11/2016
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
208 Oak Drive South
Suite 400
Lake Jackson, TX 77566
Billing Address
UTMB
301 University Blvd
Route 0510
Galveston, TX 77555
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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