Provider Demographics
NPI:1891797999
Name:OBSTETRICAL AND GYNECOLOGICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:OBSTETRICAL AND GYNECOLOGICAL ASSOCIATES, PLLC
Other - Org Name:OBSTETRICAL AND GYNECOLOGICAL ASSOCIATES, P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:RORY
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-512-7027
Mailing Address - Street 1:PO BOX 4048
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4048
Mailing Address - Country:US
Mailing Address - Phone:713-512-7000
Mailing Address - Fax:713-512-7082
Practice Address - Street 1:7900 FANNIN ST
Practice Address - Street 2:SUITE 4000
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2934
Practice Address - Country:US
Practice Address - Phone:713-512-7000
Practice Address - Fax:713-512-7082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-02
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9508207V00000X
TX207VE0102X, 207VG0400X, 2085R0202X, 2085U0001X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144808601Medicaid
TX147769701Medicaid
TXCN9938OtherRAILROAD MEDICARE
TX079778901Medicaid
TX144808601Medicaid
TX00071FMedicare ID - Type UnspecifiedHARRIS COUNTY
TX00074FMedicare ID - Type UnspecifiedFT. BEND COUNTY