Provider Demographics
NPI:1043526262
Name:SPECIALIZED WOMENS HEALTHCARE PLLC
Entity Type:Organization
Organization Name:SPECIALIZED WOMENS HEALTHCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:CMOM
Authorized Official - Phone:469-326-1600
Mailing Address - Street 1:3804 W 15TH ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-4752
Mailing Address - Country:US
Mailing Address - Phone:469-326-1600
Mailing Address - Fax:469-326-1608
Practice Address - Street 1:3804 W 15TH ST
Practice Address - Street 2:SUITE 140
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-4752
Practice Address - Country:US
Practice Address - Phone:469-326-1600
Practice Address - Fax:469-326-1608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-25
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty