Provider Demographics
NPI:1558688614
Name:BROWNSVILLE CLINIC FOR WOMEN, PA
Entity Type:Organization
Organization Name:BROWNSVILLE CLINIC FOR WOMEN, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:C
Authorized Official - Last Name:DRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-554-0775
Mailing Address - Street 1:3150 INTERNATIONAL BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-3214
Mailing Address - Country:US
Mailing Address - Phone:956-554-0775
Mailing Address - Fax:956-504-1231
Practice Address - Street 1:3150 INTERNATIONAL BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3214
Practice Address - Country:US
Practice Address - Phone:956-554-0775
Practice Address - Fax:956-504-1231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2227305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147063501Medicaid