Provider Demographics
NPI:1659480481
Name:SOUTH AUSTIN WOMENS HEALTHCARE PA
Entity Type:Organization
Organization Name:SOUTH AUSTIN WOMENS HEALTHCARE PA
Other - Org Name:THE WOMEN'S HEALTH TEAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:MUMFREY
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:512-326-5175
Mailing Address - Street 1:PO BOX 40699
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-0012
Mailing Address - Country:US
Mailing Address - Phone:512-326-5175
Mailing Address - Fax:512-326-5131
Practice Address - Street 1:4316 JAMES CASEY ST
Practice Address - Street 2:SUITE B-101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1116
Practice Address - Country:US
Practice Address - Phone:512-326-5175
Practice Address - Fax:512-326-5131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1955207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0011MWOtherBCBS GROUP
TX0011MWOtherBCBS GROUP