Provider Demographics
NPI:1760633887
Name:PLANNED PARENTHOOD OF NORTH TEXAS - SOUTHEAST HEALTH SERVICES
Entity Type:Organization
Organization Name:PLANNED PARENTHOOD OF NORTH TEXAS - SOUTHEAST HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF CLINIC OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-363-2004
Mailing Address - Street 1:7424 GREENVILLE AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4534
Mailing Address - Country:US
Mailing Address - Phone:214-363-2004
Mailing Address - Fax:214-696-2091
Practice Address - Street 1:3863 MILLER AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-2965
Practice Address - Country:US
Practice Address - Phone:817-536-4942
Practice Address - Fax:817-536-6205
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLANNED PARENTHOOD OF NORTH TEXAS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-07
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1364812-14Medicaid