Provider Demographics
NPI:1265741755
Name:MADEWELL WOMAN
Entity type:Organization
Organization Name:MADEWELL WOMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-821-5400
Mailing Address - Street 1:3310 LIVE OAK ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-6153
Mailing Address - Country:US
Mailing Address - Phone:214-821-5400
Mailing Address - Fax:214-821-5415
Practice Address - Street 1:2509 THOMAS AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-2039
Practice Address - Country:US
Practice Address - Phone:214-220-0100
Practice Address - Fax:214-821-5415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing