Provider Demographics
NPI:1326134594
Name:MAXIE C SPROTT II MD PA
Entity Type:Organization
Organization Name:MAXIE C SPROTT II MD PA
Other - Org Name:CENTER FOR WOMENS HEALTH & BIRTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VIDA
Authorized Official - Middle Name:RISTON
Authorized Official - Last Name:SPROTT
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, FNP
Authorized Official - Phone:409-838-4472
Mailing Address - Street 1:2627 CALDER ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1916
Mailing Address - Country:US
Mailing Address - Phone:409-838-4472
Mailing Address - Fax:409-838-0496
Practice Address - Street 1:2627 CALDER ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1916
Practice Address - Country:US
Practice Address - Phone:409-838-4472
Practice Address - Fax:409-838-0496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2230174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092489601Medicaid
TX092489601Medicaid