Provider Demographics
NPI:1700286333
Name:FEMVIDA, PLLC
Entity Type:Organization
Organization Name:FEMVIDA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:CHUPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-262-3822
Mailing Address - Street 1:1211 W ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-6158
Mailing Address - Country:US
Mailing Address - Phone:432-262-3822
Mailing Address - Fax:432-262-4824
Practice Address - Street 1:1211 W ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6158
Practice Address - Country:US
Practice Address - Phone:432-262-3822
Practice Address - Fax:432-262-4824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-02
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6119207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty