Provider Demographics
NPI:1194047084
Name:SOUTHEAST TEXAS WOMEN'S HEALTH PA
Entity type:Organization
Organization Name:SOUTHEAST TEXAS WOMEN'S HEALTH PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:T
Authorized Official - Last Name:BACKARDJIEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-722-9995
Mailing Address - Street 1:3141 SABA LN
Mailing Address - Street 2:
Mailing Address - City:PORT NECHES
Mailing Address - State:TX
Mailing Address - Zip Code:77651-5421
Mailing Address - Country:US
Mailing Address - Phone:409-722-9995
Mailing Address - Fax:
Practice Address - Street 1:3141 SABA LN
Practice Address - Street 2:
Practice Address - City:PORT NECHES
Practice Address - State:TX
Practice Address - Zip Code:77651-5421
Practice Address - Country:US
Practice Address - Phone:409-722-9995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4270207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty