MEDICARE: UTMB REGIONAL MATERNAL AND CHILD HEALTH PROGRAM

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	261QF0050X	Non-Surgical Family Planning Clinic/Center

General Provider Information

NPI Number	:	1609954189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UTMB REGIONAL MATERNAL AND CHILD HEALTH PROGRAM

Provider Business Mailing Address
First Line	:	301 UNIVERSITY BLVD
Second Line	:	ROUTE - 1078
City	:	GALVESTON
State	:	TX
Zip	:	77555-1078
Country	:	US
Telephone Number	:	409-772-7725
Fax Number	:	409-772-7726

Provider Business Practice Location Address
First Line	:	1108 A EAST MULBERRY
Second Line	:
City	:	ANGLETON
State	:	TX
Zip	:	77515
Country	:	US
Telephone Number	:	979-849-0692
Fax Number	:	979-849-1094

Authorized Official
Title or Position	:	DIRECTOR, CLINICAL SUPPORT SERVICES
Name	:	MS. LIZ CASTILLO
Credential	:
Telephone Number	:	409-772-7725

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	08/22/2020

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