Provider Demographics
NPI:1649677329
Name:KATY ADVANCED OBGYN, PLLC
Entity type:Organization
Organization Name:KATY ADVANCED OBGYN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-512-7083
Mailing Address - Street 1:PO BOX 3140
Mailing Address - Street 2:DEPARTMENT 900
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77253-3140
Mailing Address - Country:US
Mailing Address - Phone:832-553-5450
Mailing Address - Fax:281-347-2300
Practice Address - Street 1:23920 KATY FWY
Practice Address - Street 2:SUITE 480
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-1341
Practice Address - Country:US
Practice Address - Phone:832-553-5450
Practice Address - Fax:281-347-2300
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST WOMEN'S HEALTH ALLIANCE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty