Provider Demographics
NPI:1194913657
Name:ASSOCIATES IN OBSTETRICS & GYNECOLOGY PA
Entity type:Organization
Organization Name:ASSOCIATES IN OBSTETRICS & GYNECOLOGY PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHANTAL
Authorized Official - Middle Name:HJ
Authorized Official - Last Name:SPURDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-684-5010
Mailing Address - Street 1:1615 HOSPITAL PARKWAY
Mailing Address - Street 2:SUITES 100
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022
Mailing Address - Country:US
Mailing Address - Phone:817-684-5010
Mailing Address - Fax:817-684-5030
Practice Address - Street 1:1615 HOSPITAL PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022
Practice Address - Country:US
Practice Address - Phone:817-684-5010
Practice Address - Fax:817-684-5030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207V00000X
207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00973KMedicare PIN