Provider Demographics
NPI:1912037516
Name:ABILENE PERINATAL ASSOCIATES, P.L.L.C.
Entity Type:Organization
Organization Name:ABILENE PERINATAL ASSOCIATES, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:MABERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:325-670-6690
Mailing Address - Street 1:1850 HICKORY ST FL 2
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2325
Mailing Address - Country:US
Mailing Address - Phone:325-670-6690
Mailing Address - Fax:325-670-6593
Practice Address - Street 1:1850 HICKORY ST FL 2
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2325
Practice Address - Country:US
Practice Address - Phone:325-670-6690
Practice Address - Fax:325-670-6593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5322174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0060KAOtherBLUE CROSS BLUE SHIELD
TX159417801Medicaid
TX00513VMedicare ID - Type UnspecifiedMEDICARE PROVIDER