Provider Demographics
NPI:1922112192
Name:WACO CENTER FOR WOMEN'S HEALTH, P.A.
Entity Type:Organization
Organization Name:WACO CENTER FOR WOMEN'S HEALTH, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLILAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-776-8291
Mailing Address - Street 1:601 W STATE HIGHWAY 6
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-5575
Mailing Address - Country:US
Mailing Address - Phone:254-772-5454
Mailing Address - Fax:254-772-6464
Practice Address - Street 1:601 WEST HIGHWAY 6
Practice Address - Street 2:SUITE 101
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-5575
Practice Address - Country:US
Practice Address - Phone:254-772-5454
Practice Address - Fax:254-772-6464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164602802Medicaid
TX164602802Medicaid
TX5398450001Medicare NSC