Provider Demographics
NPI:1235320904
Name:WILLIAM T TIMMONS
Entity Type:Organization
Organization Name:WILLIAM T TIMMONS
Other - Org Name:THE JASPER WOMEN'S CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:G
Authorized Official - Last Name:WAGUSPACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-384-6000
Mailing Address - Street 1:2014 S WHEELER ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-5624
Mailing Address - Country:US
Mailing Address - Phone:409-384-6000
Mailing Address - Fax:409-384-2026
Practice Address - Street 1:2014 S WHEELER ST
Practice Address - Street 2:SUITE 130
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-5624
Practice Address - Country:US
Practice Address - Phone:409-384-6000
Practice Address - Fax:409-384-2026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4720207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10110570OtherDPS
TXE4720OtherSTATE LICENSE
TX00AJ43OtherBLUE CROSS/SLUE SHIELD
TX00AJ43OtherBLUE CROSS/SLUE SHIELD
TXAT6729620OtherDEA
TXE4720OtherSTATE LICENSE