Provider Demographics
NPI:1154474674
Name:THE SPECIALISTS FOR WOMEN OF TEXARKANA PLLC
Entity Type:Organization
Organization Name:THE SPECIALISTS FOR WOMEN OF TEXARKANA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTEN
Authorized Official - Suffix:
Authorized Official - Credentials:CMOM CMC
Authorized Official - Phone:903-792-4808
Mailing Address - Street 1:1002 TEXAS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-5133
Mailing Address - Country:US
Mailing Address - Phone:903-792-4808
Mailing Address - Fax:903-792-2681
Practice Address - Street 1:1002 TEXAS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-5133
Practice Address - Country:US
Practice Address - Phone:903-792-4808
Practice Address - Fax:903-792-2681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2351174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00675XMedicare PIN