University of Texas Medical Branch

Primary specialty

State or Local Public Health Clinic/CenterTaxonomy code 261QP0905X

Legal business name

UNIVERSITY OF TEXAS MEDICAL BRANCH

Practice address

301 University Blvd
417 Jennie Sealy Hospital
Galveston, TX 77555-0462

Phone

(409) 772-4194

Fax

(409) 772-9785

NPI assigned

May 31, 2007

Last updated

Aug 22, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Kim Pandanell

Title

Program Manager, Residency Training

Phone

(409) 772-4194

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• University of Texas Medical Branch at Galveston

  dba University of Texas Medical Branch

  • Community/Retail Pharmacy
  • Galveston, TX
  • NPI 1306802384

  O20100930024280

  Same enrollment

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187740800000",
    "number": "1033310388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 UNIVERSITY BLVD",
            "address_2": "417 JENNIE SEALY HOSPITAL",
            "city": "GALVESTON",
            "state": "TX",
            "postal_code": "775550462",
            "telephone_number": "409-772-4194",
            "fax_number": "409-772-9785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 UNIVERSITY BLVD",
            "address_2": "417 JENNIE SEALY HOSPITAL",
            "city": "GALVESTON",
            "state": "TX",
            "postal_code": "775550462",
            "telephone_number": "409-772-4194",
            "fax_number": "409-772-9785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF TEXAS MEDICAL BRANCH",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-31",
        "last_updated": "2007-08-22",
        "status": "A",
        "authorized_official_last_name": "PANDANELL",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "PROGRAM MANAGER, RESIDENCY TRAINING",
        "authorized_official_telephone_number": "409-772-4194",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QP0905X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, State or Local",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Carol Tyler, GNP
• Hamza Uddin, MD
• Agnes Ikpoto Udoh, MD
• Duane Joseph Ullman, O.D.
• Adaku Ume, MD, PHD
• University of Texas Medical Branch
• University of Texas Medical Branch
• University of Texas Medical Branch (UTMB Providers)
• University of Texas Medical Branch
• University of Texas Medical Branch at Galveston

• State or Local Public Health Clinic/Center in Galveston, TX
• Providers in Galveston, TX by specialty
• State or Local Public Health Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.