Provider Demographics
NPI:1245781822
Name:CENTENNIAL OB GYN, P.A.
Entity Type:Organization
Organization Name:CENTENNIAL OB GYN, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUSONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-731-6565
Mailing Address - Street 1:5757 WARREN PARKWAY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4777
Mailing Address - Country:US
Mailing Address - Phone:972-731-6565
Mailing Address - Fax:972-731-6570
Practice Address - Street 1:5757 WARREN PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4274
Practice Address - Country:US
Practice Address - Phone:972-731-6565
Practice Address - Fax:972-731-6570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00307XMedicare PIN