Provider Demographics
NPI:1750725131
Name:WOMANS CLINIC AT LIVINGSTON PLLC
Entity type:Organization
Organization Name:WOMANS CLINIC AT LIVINGSTON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHESH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHETTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-570-7300
Mailing Address - Street 1:4100 INTERNATIONAL PLZ
Mailing Address - Street 2:STE 240
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4820
Mailing Address - Country:US
Mailing Address - Phone:817-570-7300
Mailing Address - Fax:817-570-7062
Practice Address - Street 1:111 EMERGENCY DR.
Practice Address - Street 2:STE C
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351
Practice Address - Country:US
Practice Address - Phone:817-570-7300
Practice Address - Fax:817-570-7062
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOMAN'S CLINIC PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-29
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty