Provider Demographics
NPI:1124357249
Name:WHOLE WOMAN'S HEALTH OF FORT WORTH LLC
Entity Type:Organization
Organization Name:WHOLE WOMAN'S HEALTH OF FORT WORTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/CREDENTIALING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-737-9615
Mailing Address - Street 1:1717 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-1626
Mailing Address - Country:US
Mailing Address - Phone:817-924-6641
Mailing Address - Fax:
Practice Address - Street 1:8401 N I H 35
Practice Address - Street 2:SUITE 1A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-5751
Practice Address - Country:US
Practice Address - Phone:512-835-6858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-19
Last Update Date:2009-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX140000207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty