Provider Demographics
NPI:1073663514
Name:WOMEN'S HEALTH CONNECTIONS
Entity Type:Organization
Organization Name:WOMEN'S HEALTH CONNECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUCMIERZ
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:903-731-7000
Mailing Address - Street 1:P.O. BOX 145
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801
Mailing Address - Country:US
Mailing Address - Phone:903-731-7000
Mailing Address - Fax:903-731-7016
Practice Address - Street 1:3215 W. OAK ST.
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801
Practice Address - Country:US
Practice Address - Phone:903-731-7000
Practice Address - Fax:903-731-7016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QA0005X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1883837Medicaid
00X467Medicare PIN