Provider Demographics
NPI:1578768701
Name:NORTH TEXAS WOMENS HEALTH CARE ASSOCIATES P A
Entity Type:Organization
Organization Name:NORTH TEXAS WOMENS HEALTH CARE ASSOCIATES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:B
Authorized Official - Last Name:PETIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-741-2601
Mailing Address - Street 1:1141 KELLER PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-1627
Mailing Address - Country:US
Mailing Address - Phone:817-741-2601
Mailing Address - Fax:817-745-2601
Practice Address - Street 1:1141 KELLER PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-1627
Practice Address - Country:US
Practice Address - Phone:817-741-2601
Practice Address - Fax:817-745-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0130HMOtherGROUP BCBS
TX00Z012Medicare PIN