Provider Demographics
NPI:1740434166
Name:LEWISVILLE OBSTETRICS & GYNECOLOGY ASSOCIATES, PA
Entity type:Organization
Organization Name:LEWISVILLE OBSTETRICS & GYNECOLOGY ASSOCIATES, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:AUERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-420-1470
Mailing Address - Street 1:4001 LONG PRAIRIE RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1565
Mailing Address - Country:US
Mailing Address - Phone:972-420-1470
Mailing Address - Fax:972-420-1465
Practice Address - Street 1:4001 LONG PRAIRIE RD
Practice Address - Street 2:SUITE 150
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1565
Practice Address - Country:US
Practice Address - Phone:972-420-1470
Practice Address - Fax:972-420-1465
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEWISVILLE OBSTETRICS & GYNECOLOGY ASSOCIATES, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-12
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081987201Medicaid
TXD08NOtherMEDICARE ID