Provider Demographics
NPI:1194970152
Name:MARY F. HEWITT, M.D., P.A.
Entity type:Organization
Organization Name:MARY F. HEWITT, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:HEWITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-427-6363
Mailing Address - Street 1:PO BOX 2115
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77522-2115
Mailing Address - Country:US
Mailing Address - Phone:281-427-6363
Mailing Address - Fax:281-420-6867
Practice Address - Street 1:2610 N ALEXANDER DR
Practice Address - Street 2:SUITE 201
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-3368
Practice Address - Country:US
Practice Address - Phone:281-427-6363
Practice Address - Fax:281-420-6867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5553207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092503401Medicaid
TX0047ENOtherBLUE CROSS & BLUE SHIELD
TX8F9488OtherINDIVIDUAL NPI/DR.MARY FAYE HEWITT M.D.
TX0047ENOtherBLUE CROSS & BLUE SHIELD
TX092503401Medicaid