Provider Demographics
NPI:1720088644
Name:HIDE-A-WAY WOMEN'S HEALTH AND BIRTH CENTER
Entity Type:Organization
Organization Name:HIDE-A-WAY WOMEN'S HEALTH AND BIRTH CENTER
Other - Org Name:WOMEN'S HEALTH AND BIRTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:903-882-4730
Mailing Address - Street 1:14665 FM 849
Mailing Address - Street 2:
Mailing Address - City:LINDALE
Mailing Address - State:TX
Mailing Address - Zip Code:75771-2440
Mailing Address - Country:US
Mailing Address - Phone:903-882-4730
Mailing Address - Fax:903-881-8319
Practice Address - Street 1:14665 FM 849
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-2440
Practice Address - Country:US
Practice Address - Phone:903-882-4730
Practice Address - Fax:903-881-8319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX007191261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR92880Medicare UPIN