Provider Demographics
NPI:1669731535
Name:HUNTSVILLE WOMENS CENTER, LP
Entity type:Organization
Organization Name:HUNTSVILLE WOMENS CENTER, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:KANADY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-439-4828
Mailing Address - Street 1:PO BOX 8399
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77387-8399
Mailing Address - Country:US
Mailing Address - Phone:281-364-1707
Mailing Address - Fax:281-364-0028
Practice Address - Street 1:123 B MEDICAL PARK LANE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-4981
Practice Address - Country:US
Practice Address - Phone:936-439-4828
Practice Address - Fax:936-439-4833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX239294261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM01208OtherMAMMOGRAPHY CERTIFICATION
TX239294OtherACR