Provider Demographics
NPI:1104854777
Name:TEXOMA WOMENS CLINIC P.A.
Entity Type:Organization
Organization Name:TEXOMA WOMENS CLINIC P.A.
Other - Org Name:THE WOMENS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:JEREMY
Authorized Official - Last Name:BANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-723-8571
Mailing Address - Street 1:6 BURNSIDE
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76310-1128
Mailing Address - Country:US
Mailing Address - Phone:940-723-8151
Mailing Address - Fax:940-723-8815
Practice Address - Street 1:6 BURNSIDE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-1128
Practice Address - Country:US
Practice Address - Phone:940-723-8151
Practice Address - Fax:940-723-8815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA02882Medicare UPIN
TXC23886Medicare UPIN
TXI59253Medicare UPIN
TXH17603Medicare UPIN