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General NPI Number Information
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NPI Number | 1063821981
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Entity Type | Organization
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Legal Business Name | UTMB
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Dates
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Enumeration Date | 08/05/2014
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Last Update Date | 08/05/2014
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Provider Practice Location Address
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Address Line | 12603 SOUTHWEST FWY STE 335
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City | STAFFORD
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State | TX
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Zip | 77477-3842
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Country | US
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Telephone | 281-269-6700
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Fax | 281-265-5163
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Provider Business Mailing Address
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Address Line | 12603 SOUTHWEST FWY STE 335
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City | STAFFORD
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State | TX
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Zip | 77477-3842
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Country | US
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Telephone | 281-269-6700
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Fax | 281-265-5163
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Authorized Official
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Title or Position | PROVIDER
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Name | MS. SANDRA K SMOCK
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Credential | APN
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Telephone | 281-269-6700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2400X
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Taxonomy Name | Prison Health Clinic/Center
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License Number | 233196
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License Number State | TX
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