Provider Demographics
NPI:1598027310
Name:COMPREHENSIVE FAMILY AND WOMENS HEALTHCARE
Entity Type:Organization
Organization Name:COMPREHENSIVE FAMILY AND WOMENS HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORNELIA
Authorized Official - Middle Name:SELMA
Authorized Official - Last Name:DE RIESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:806-761-0741
Mailing Address - Street 1:2202 N BRYAN AVE
Mailing Address - Street 2:
Mailing Address - City:LAMESA
Mailing Address - State:TX
Mailing Address - Zip Code:79331-2451
Mailing Address - Country:US
Mailing Address - Phone:806-761-0741
Mailing Address - Fax:806-872-5917
Practice Address - Street 1:2202 N BRYAN AVE
Practice Address - Street 2:
Practice Address - City:LAMESA
Practice Address - State:TX
Practice Address - Zip Code:79331-2451
Practice Address - Country:US
Practice Address - Phone:806-761-0741
Practice Address - Fax:806-872-5917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6348207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG35172OtherNUMBERS PENDING