Provider Demographics
NPI:1760563464
Name:SAGEBRUSH WOMEN'S HEALTHCARE
Entity Type:Organization
Organization Name:SAGEBRUSH WOMEN'S HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ONEIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-253-5000
Mailing Address - Street 1:2609 SAGEBRUSH DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2733
Mailing Address - Country:US
Mailing Address - Phone:972-253-5000
Mailing Address - Fax:
Practice Address - Street 1:2001 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 504
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2222
Practice Address - Country:US
Practice Address - Phone:972-253-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3812207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143575201Medicaid
TX143575201Medicaid