Provider Demographics
NPI:1205035631
Name:SOUTHEAST TEXAS FAMILY PLANNING AND CANCER SCREENING
Entity Type:Organization
Organization Name:SOUTHEAST TEXAS FAMILY PLANNING AND CANCER SCREENING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:BOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-774-6550
Mailing Address - Street 1:6565 DE MOSS DR STE 112
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-5021
Mailing Address - Country:US
Mailing Address - Phone:713-774-6550
Mailing Address - Fax:713-774-7156
Practice Address - Street 1:6565 DE MOSS DR STE 112
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-5021
Practice Address - Country:US
Practice Address - Phone:713-774-6550
Practice Address - Fax:713-774-7156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC1836251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133590306Medicaid