Provider Demographics
NPI:1740441302
Name:GEORGETOWN OB GYN LLP
Entity type:Organization
Organization Name:GEORGETOWN OB GYN LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:S
Authorized Official - Last Name:SANTIFER
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:512-863-8600
Mailing Address - Street 1:PO BOX 1223
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78627-1223
Mailing Address - Country:US
Mailing Address - Phone:512-863-8600
Mailing Address - Fax:512-863-8641
Practice Address - Street 1:602 HIGH TECH DRIVE
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626
Practice Address - Country:US
Practice Address - Phone:512-863-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7214207V00000X
TXH7653207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00046MOtherMEDICARE
1000866BOtherAMERIGROUP
428883006OtherCIGNA
10008667OtherAMERICGROUP
2290118OtherAETNA HMO
TX0962581 02Medicaid
21149582824 01OtherBEECHSTREET
3361599OtherBLUE LINK
5320762OtherAETNA HMO
00046MOtherBCBS
0058487OtherBLUE LINK
2290279OtherAETNA PPO
00L62JOtherBCBS
TX1235269 03Medicaid
4393421OtherAETNA PPO
00L62JOtherMEDICARE
2949121001OtherCIGNA
2949121001OtherCIGNA
BS 2979928OtherDEA
00046MOtherMEDICARE
F61599Medicare UPIN