| Utmb Faculty Group Practice | |
|
313 E 12th St Austin TX 78701-1954 | |
| (409) 772-2222 | |
| Not Available |
| Full Name | Utmb Faculty Group Practice |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 313 E 12th St, Austin, Texas |
| Authorized Official Name and Position | Cynthia L. Smith (DIRECTOR) |
| Authorized Official Contact | 4097722222 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Utmb Faculty Group Practice P O Box 4797-710 Houston TX 77210-4797 Ph: (409) 772-2222 | Utmb Faculty Group Practice 313 E 12th St Austin TX 78701-1954 Ph: (409) 772-2222 |
| NPI Number | 1114968294 |
|---|---|
| Provider Enumeration Date | 06/09/2006 |
| Last Update Date | 09/22/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114968294 | NPI | - | NPPES |
| 112048705 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (NU) | Primary |
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