University of Texas Medical Branch at Galveston

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON

Practice address

301 University Blvd
RT 1076
Galveston, TX 77555-1388

Phone

(409) 747-6520

Fax

(409) 747-0164

NPI assigned

Apr 26, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Charles P Mouton, MD

Title

President Ad Interim

Phone

(409) 772-1902

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• University of Texas Medical Branch Doing business as

Locations

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662422400000",
    "number": "1821054883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 UNIVERSITY BLVD",
            "city": "GALVESTON",
            "state": "TX",
            "postal_code": "775550115",
            "telephone_number": "409-747-8783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 UNIVERSITY BLVD",
            "address_2": "RT 1076",
            "city": "GALVESTON",
            "state": "TX",
            "postal_code": "775551388",
            "telephone_number": "409-747-6520",
            "fax_number": "409-747-0164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF TEXAS MEDICAL BRANCH AT GALVESTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-26",
        "last_updated": "2022-09-06",
        "certification_date": "2022-09-06",
        "status": "A",
        "authorized_official_last_name": "MOUTON",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT AD INTERIM",
        "authorized_official_telephone_number": "409-772-1902",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "085973802",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "University of Texas Medical Branch",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "University of Texas Medical Branch",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• University of Texas Medical Branch
• University of Texas Medical Branch at Galveston
• University of Texas Medical Branch at Galveston
• University of Texas Medical Branch at Galveston
• University of Texas Medical Branch at Galveston
• University of Texas Medical Branch Outpatient Pharmacy
• Shannon Unruh
• Randall J Urban, MD
• Tomas Eduardo Uribe Acosta, MD
• US Coast Guard

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Galveston, TX
• Providers in Galveston, TX by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.