Provider Demographics
NPI:1164770335
Name:WHBOUTIQUE INC.
Entity Type:Organization
Organization Name:WHBOUTIQUE INC.
Other - Org Name:WOMEN'S HEALTH BOUTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:D
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:CMF, COF
Authorized Official - Phone:903-758-9904
Mailing Address - Street 1:605 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-6606
Mailing Address - Country:US
Mailing Address - Phone:903-758-9904
Mailing Address - Fax:903-236-9786
Practice Address - Street 1:1322 N BECKLEY AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1254
Practice Address - Country:US
Practice Address - Phone:214-948-3999
Practice Address - Fax:214-948-3993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-20
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000975332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX331888303 - CSNMedicaid
TX331888301Medicaid
TX533963OtherBCBSTX
TX331888301Medicaid
TX6954550003Medicare NSC