MEDICARE: UT PHYSICIANS SPECIALTY SERVICES

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	208000000X	Pediatrics Physician
2	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184158941
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UT PHYSICIANS SPECIALTY SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 301448
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75303-1448
Country	:	US
Telephone Number	:	713-500-3500
Fax Number	:

Provider Business Practice Location Address
First Line	:	7364 ANTOINE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77088-7230
Country	:	US
Telephone Number	:	713-486-7350
Fax Number	:	713-486-0854

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	ANDREW R CASAS
Credential	:
Telephone Number	:	732-325-7325

Provider Enumeration Date	:	04/18/2017
Last Update Date	:	05/04/2021

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Directions to “UT PHYSICIANS SPECIALTY SERVICES ” Practice Location

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