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	:	1851478010
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	:
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	:	5819 10TH ST
Second Line	:	STE. A
City	:	KATY
State	:	TX
Zip	:	77493-1636
Country	:	US
Telephone Number	:	281-391-7001
Fax Number	:	281-391-8175

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

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

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Practice Location Address:

5819 10TH ST , SUITE A
KATY, TX
77493-1636

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5819 10TH ST , STE A
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1417146242 — LYNETTE R LAAS RN
Practice Location Address:

5819 10TH ST , STE A
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