Provider Demographics
NPI:1710090451
Name:JESELLE A MATHEWS, MDPA
Entity Type:Organization
Organization Name:JESELLE A MATHEWS, MDPA
Other - Org Name:WOMENS DIAGNOSTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JESELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-580-0580
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-0027
Mailing Address - Country:US
Mailing Address - Phone:956-580-0580
Mailing Address - Fax:956-580-7631
Practice Address - Street 1:2134 E. GRIFFIN PKWY
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572
Practice Address - Country:US
Practice Address - Phone:956-580-0580
Practice Address - Fax:956-580-7631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6416207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135573704Medicaid
TX00T45NOtherBLUE CROSS BLUE SHIELD
TXE92358Medicare UPIN
TX135573704Medicaid