Provider Demographics
NPI:1851611933
Name:ADVANCED WOMENS HEALTHCARE OF WAXAHACHIE PLLC
Entity Type:Organization
Organization Name:ADVANCED WOMENS HEALTHCARE OF WAXAHACHIE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GLASS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:325-437-1590
Mailing Address - Street 1:2001 BATES DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75167-4828
Mailing Address - Country:US
Mailing Address - Phone:469-570-7001
Mailing Address - Fax:469-570-7002
Practice Address - Street 1:2001 BATES DR STE 200
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75167-4828
Practice Address - Country:US
Practice Address - Phone:469-570-7001
Practice Address - Fax:469-570-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1649207V00000X
TX207V00000X
TX782340363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB114087Medicare PIN