Provider Demographics
NPI:1013268747
Name:WHBOUTIQUE INC.
Entity Type:Organization
Organization Name:WHBOUTIQUE INC.
Other - Org Name:WOMEN'S HEALTH BOUTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:D
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:CMF, COF
Authorized Official - Phone:903-758-9904
Mailing Address - Street 1:605 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-6606
Mailing Address - Country:US
Mailing Address - Phone:903-758-9904
Mailing Address - Fax:903-236-9786
Practice Address - Street 1:3115 W PARKER RD
Practice Address - Street 2:SUITE 270
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-8129
Practice Address - Country:US
Practice Address - Phone:972-985-4477
Practice Address - Fax:972-596-3898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-20
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000993332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX533962OtherBCBSTX
TX3495830-01Medicaid
TX533962OtherBCBSTX
TX3495830-03Medicaid
TX3495830-02Medicaid