Provider Demographics
NPI:1790900355
Name:BLUEBONNET OB GYN
Entity Type:Organization
Organization Name:BLUEBONNET OB GYN
Other - Org Name:SMITHVILLE REGIONAL HOSPITAL AUTHORITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:NORALENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-237-3214
Mailing Address - Street 1:81 LOOP 150 W
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-3930
Mailing Address - Country:US
Mailing Address - Phone:512-308-9100
Mailing Address - Fax:512-308-9101
Practice Address - Street 1:81 LOOP 150 W
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-3930
Practice Address - Country:US
Practice Address - Phone:512-308-9100
Practice Address - Fax:512-308-9101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty