MEDICARE: UTMB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305S00000X	Point of Service	PA00673	TX

General Provider Information

NPI Number	:	1811394208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UTMB

Provider Business Mailing Address
First Line	:	2350 ATASCOCITA RD
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77396-3503
Country	:	US
Telephone Number	:	281-454-5036
Fax Number	:

Provider Business Practice Location Address
First Line	:	2350 ATASCOCITA RD
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77396-3503
Country	:	US
Telephone Number	:	281-454-5036
Fax Number	:

Authorized Official
Title or Position	:	UNIT HEALTH AUTHORTHY
Name	:	MR. ERIC WILSON JOHNSON
Credential	:	MD
Telephone Number	:	281-454-5036

Provider Enumeration Date	:	12/01/2014
Last Update Date	:	12/01/2014

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Directions to “UTMB ” Practice Location

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