Provider Demographics
NPI:1891177804
Name:FERTILITY INSTITUTE OF TEXAS, PLLC
Entity Type:Organization
Organization Name:FERTILITY INSTITUTE OF TEXAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-660-8442
Mailing Address - Street 1:540 OAK CENTRE DR STE 260
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4767
Mailing Address - Country:US
Mailing Address - Phone:210-277-8111
Mailing Address - Fax:830-620-9077
Practice Address - Street 1:540 OAK CENTRE DR STE 260
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4767
Practice Address - Country:US
Practice Address - Phone:210-277-8111
Practice Address - Fax:830-620-9077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9256207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1194927285OtherNPI
1649289927OtherNPI