| Organization Name: | UTMB |
| NPI Number: | 1063821981 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SANDRA K SMOCK (PROVIDER) |
| Mailing Address: | 12603 Southwest Fwy Ste 335 Stafford |
| State: | TX US |
| Postal Code: | 774773842 |
| Phone Number: | 2812696700 |
| Fax Number: | 2812655163 |
| NPI Enumeration Date: | 08/05/2014 |
| NPI Last Update Date: | 08/05/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2400X |
| License Number: | 233196 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Prison Health |
| Taxonomy Definition: | |