Provider Demographics
NPI:1053320960
Name:WOMEN AND CHILDREN FIRST, PA
Entity Type:Organization
Organization Name:WOMEN AND CHILDREN FIRST, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IT/ OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:T
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-997-3132
Mailing Address - Street 1:816 REUBEN ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624
Mailing Address - Country:US
Mailing Address - Phone:830-997-3132
Mailing Address - Fax:830-997-6175
Practice Address - Street 1:816 REUBEN ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624
Practice Address - Country:US
Practice Address - Phone:830-997-3132
Practice Address - Fax:830-997-6175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092250203Medicaid
TX00266KMedicare PIN