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General NPI Number Information
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NPI Number | 1568937100
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Entity Type | Organization
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Legal Business Name | UT PHYSICIANS SPECIALTY SERVICES
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Dates
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Enumeration Date | 10/10/2018
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Last Update Date | 10/10/2018
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Provider Practice Location Address
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Address Line | 5656 KELLEY ST
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City | HOUSTON
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State | TX
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Zip | 77026-1967
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Country | US
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Telephone | 713-566-5656
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Fax | 713-500-5484
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Provider Business Mailing Address
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Address Line | PO BOX 301448
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City | DALLAS
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State | TX
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Zip | 75303-1448
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Country | US
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Telephone | 832-325-6500
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | ANDREW CASAS
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Credential |
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Telephone | 832-325-7325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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