Provider Demographics
NPI:1003366485
Name:TERRELL OB/GYN PLLC
Entity Type:Organization
Organization Name:TERRELL OB/GYN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE
Authorized Official - Prefix:MRS
Authorized Official - First Name:DWON
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEVINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-454-2130
Mailing Address - Street 1:PO BOX 8115
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75404-8115
Mailing Address - Country:US
Mailing Address - Phone:903-454-2130
Mailing Address - Fax:903-454-5487
Practice Address - Street 1:109 TEJAS DR
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-6676
Practice Address - Country:US
Practice Address - Phone:903-454-2130
Practice Address - Fax:903-454-5487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty