Provider Demographics
NPI:1326163916
Name:WOMENS CENTRE FOR WELL BEING PA
Entity Type:Organization
Organization Name:WOMENS CENTRE FOR WELL BEING PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:EADS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-813-0979
Mailing Address - Street 1:1120 MEDICAL PLAZA DR
Mailing Address - Street 2:200
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3242
Mailing Address - Country:US
Mailing Address - Phone:832-813-0979
Mailing Address - Fax:832-813-0984
Practice Address - Street 1:1120 MEDICAL PLAZA DR
Practice Address - Street 2:200
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3242
Practice Address - Country:US
Practice Address - Phone:832-813-0979
Practice Address - Fax:832-813-0984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4048174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184714701Medicaid
TXP00385879OtherMEDICARE RAILROAD PTAN
VA160000887Medicare ID - Type Unspecified
TXD58812Medicare UPIN
TX184714701Medicaid