Provider Demographics
NPI:1609204866
Name:SELECT WOMENS HEALTH PLLC
Entity Type:Organization
Organization Name:SELECT WOMENS HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:TAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-464-1845
Mailing Address - Street 1:23920 KATY FWY
Mailing Address - Street 2:STE 460
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-1341
Mailing Address - Country:US
Mailing Address - Phone:713-464-1845
Mailing Address - Fax:281-392-5081
Practice Address - Street 1:23920 KATY FWY
Practice Address - Street 2:STE 460
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-1341
Practice Address - Country:US
Practice Address - Phone:713-464-1845
Practice Address - Fax:281-392-5081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-28
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7630174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0078ZFOtherBCBS GROUP
TX099716503Medicaid
TX332533YXXROtherMEDICARE GROUP PTAN
TX099716503Medicaid
TX0078ZFOtherBCBS GROUP