Provider Demographics
NPI:1740221985
Name:WORTHAM MEDICAL CENTER P A
Entity Type:Organization
Organization Name:WORTHAM MEDICAL CENTER P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:254-765-3340
Mailing Address - Street 1:PO BOX 276
Mailing Address - Street 2:
Mailing Address - City:WORTHAM
Mailing Address - State:TX
Mailing Address - Zip Code:76693-0276
Mailing Address - Country:US
Mailing Address - Phone:254-765-3340
Mailing Address - Fax:254-765-3820
Practice Address - Street 1:618 S 3RD STREET
Practice Address - Street 2:
Practice Address - City:WORTHAM
Practice Address - State:TX
Practice Address - Zip Code:76693
Practice Address - Country:US
Practice Address - Phone:254-765-3340
Practice Address - Fax:254-765-3820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0046NTOtherBCBS TX
TX0046NTOtherBCBS TX