Provider Demographics
NPI:1457358004
Name:TOMBALL WOMENS HEALTH CARE CENTER P.A.
Entity Type:Organization
Organization Name:TOMBALL WOMENS HEALTH CARE CENTER P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-351-5548
Mailing Address - Street 1:929 GRAHAM DR
Mailing Address - Street 2:STE B
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-6451
Mailing Address - Country:US
Mailing Address - Phone:281-351-5548
Mailing Address - Fax:281-351-5020
Practice Address - Street 1:929 GRAHAM DR
Practice Address - Street 2:STE B
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-6451
Practice Address - Country:US
Practice Address - Phone:281-351-5548
Practice Address - Fax:281-351-5020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171662301Medicaid
TX0024MAOtherBLUE CROSS BLUE SHIELD
TX171662301Medicaid