Provider Demographics
NPI:1669486650
Name:KATHERINE A HAYNES MD PA
Entity Type:Organization
Organization Name:KATHERINE A HAYNES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:COOMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-741-1860
Mailing Address - Street 1:405 LONDONDERRY DR
Mailing Address - Street 2:STE 300
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7924
Mailing Address - Country:US
Mailing Address - Phone:254-741-1860
Mailing Address - Fax:254-741-1249
Practice Address - Street 1:405 LONDONDERRY DR
Practice Address - Street 2:STE 300
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7924
Practice Address - Country:US
Practice Address - Phone:254-741-1860
Practice Address - Fax:254-741-1249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I43553Medicare UPIN
TX8F1293Medicare ID - Type Unspecified