Provider Demographics
NPI:1518364223
Name:WOMEN'S PELVIC RESTORATIVE CENTER, PLLC
Entity Type:Organization
Organization Name:WOMEN'S PELVIC RESTORATIVE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-512-7083
Mailing Address - Street 1:PO BOX 3140
Mailing Address - Street 2:DEPARTMENT 900
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77253-3140
Mailing Address - Country:US
Mailing Address - Phone:713-512-7600
Mailing Address - Fax:713-512-7873
Practice Address - Street 1:7900 FANNIN ST
Practice Address - Street 2:SUITE 4000
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2934
Practice Address - Country:US
Practice Address - Phone:713-512-7600
Practice Address - Fax:713-512-7873
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST WOMEN'S HEALTH ALLIANCE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive SurgeryGroup - Single Specialty