Provider Demographics
NPI:1770675068
Name:TRI-COUNTY WOMENS HEALTHCARE
Entity Type:Organization
Organization Name:TRI-COUNTY WOMENS HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCIA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-586-8100
Mailing Address - Street 1:203 NACOGDOCHES STREET
Mailing Address - Street 2:SUITE 340
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-2444
Mailing Address - Country:US
Mailing Address - Phone:903-586-8100
Mailing Address - Fax:903-589-3791
Practice Address - Street 1:203 NACOGDOCHES STREET
Practice Address - Street 2:SUITE 340
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-2444
Practice Address - Country:US
Practice Address - Phone:903-586-8100
Practice Address - Fax:903-589-3791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9013207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0049JYOtherBCBS PIN
TXDN0776OtherMEDICARE RAILROAD PIN
TX201870701Medicaid
TXDN0776OtherMEDICARE RAILROAD PIN
TX201870701Medicaid