Provider Demographics
NPI:1538308507
Name:OB-GYN ASSOCIATES OF WACO, P.A.
Entity Type:Organization
Organization Name:OB-GYN ASSOCIATES OF WACO, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR COOWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:RISTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-752-4395
Mailing Address - Street 1:2501 AMBASSADOR DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-0000
Mailing Address - Country:US
Mailing Address - Phone:254-752-4395
Mailing Address - Fax:254-752-7343
Practice Address - Street 1:2501 AMBASSADOR DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-0000
Practice Address - Country:US
Practice Address - Phone:254-752-4395
Practice Address - Fax:254-752-7343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3732207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097556702Medicaid
TX099097002Medicaid
TX099097002Medicaid
TX00JZ43Medicare PIN