Provider Demographics
NPI:1649455106
Name:MAINLAND OB/GYN
Entity type:Organization
Organization Name:MAINLAND OB/GYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:CROWDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-335-4600
Mailing Address - Street 1:2200 NASA PKWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3745
Mailing Address - Country:US
Mailing Address - Phone:281-335-4600
Mailing Address - Fax:281-335-4662
Practice Address - Street 1:2200 NASA PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3745
Practice Address - Country:US
Practice Address - Phone:281-335-4600
Practice Address - Fax:281-335-4662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9059174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX084293201Medicaid
TX084293201Medicaid