Provider Demographics
NPI:1295127355
Name:SOLACE WOMENS CARE PA
Entity type:Organization
Organization Name:SOLACE WOMENS CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:FARLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEJOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-441-7100
Mailing Address - Street 1:690 S LOOP 336 W
Mailing Address - Street 2:220
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-3319
Mailing Address - Country:US
Mailing Address - Phone:936-441-7100
Mailing Address - Fax:936-756-7105
Practice Address - Street 1:690 S LOOP 336 W
Practice Address - Street 2:220
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3319
Practice Address - Country:US
Practice Address - Phone:936-441-7100
Practice Address - Fax:936-756-7105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-26
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP5469207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty