Provider Demographics
NPI:1184806978
Name:TERRELL WOMENS HEALTH CENTER
Entity type:Organization
Organization Name:TERRELL WOMENS HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:IMA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIDEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:972-563-5555
Mailing Address - Street 1:PO BOX 871
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-0014
Mailing Address - Country:US
Mailing Address - Phone:972-563-5555
Mailing Address - Fax:972-563-5556
Practice Address - Street 1:109 TEJAS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-6676
Practice Address - Country:US
Practice Address - Phone:972-563-5555
Practice Address - Fax:972-563-5556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3199207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty