Provider Demographics
NPI:1386732683
Name:PERSONALIZED WOMEN'S HEALTHCARE, P.A.
Entity type:Organization
Organization Name:PERSONALIZED WOMEN'S HEALTHCARE, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:JACOBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-473-2020
Mailing Address - Street 1:3108 MIDWAY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-6383
Mailing Address - Country:US
Mailing Address - Phone:972-612-5466
Mailing Address - Fax:972-473-2077
Practice Address - Street 1:3108 MIDWAY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-6383
Practice Address - Country:US
Practice Address - Phone:972-473-2020
Practice Address - Fax:972-473-2077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2501207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096500602Medicaid
TXG46851Medicare UPIN
TX8F5351Medicare PIN