Provider Demographics
NPI:1235286972
Name:WOMEN'S CLINIC OF DIMMIT AND ZAVALA P.A.
Entity Type:Organization
Organization Name:WOMEN'S CLINIC OF DIMMIT AND ZAVALA P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHEAL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-876-9625
Mailing Address - Street 1:706 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:CARRIZO SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78834-3836
Mailing Address - Country:US
Mailing Address - Phone:830-876-9625
Mailing Address - Fax:830-876-5752
Practice Address - Street 1:523 W ZAVALA ST
Practice Address - Street 2:
Practice Address - City:CRYSTAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78839-2828
Practice Address - Country:US
Practice Address - Phone:830-374-3118
Practice Address - Fax:830-876-5752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157874202Medicaid
00212ROtherMEDICARE GROUP #