Provider Demographics
NPI:1699756452
Name:NORTHEAST TEXAS WOMENS HEALTH P A
Entity type:Organization
Organization Name:NORTHEAST TEXAS WOMENS HEALTH P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:N
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-572-4664
Mailing Address - Street 1:2015 MULBERRY AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-2312
Mailing Address - Country:US
Mailing Address - Phone:903-572-4664
Mailing Address - Fax:903-572-4647
Practice Address - Street 1:2015 MULBERRY AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2312
Practice Address - Country:US
Practice Address - Phone:903-572-4664
Practice Address - Fax:903-572-4647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155802501Medicaid
TX0076JYOtherBCBS
DA9153OtherRAIL ROAD MEDICARE
121107OtherSUPERIOR HEALTH PLAN
TX155802502Medicaid
TX155802501Medicaid
121107OtherSUPERIOR HEALTH PLAN