Provider Demographics
NPI:1962720847
Name:TOTAL WOMENS CARE OF EAST TEXAS, PA
Entity type:Organization
Organization Name:TOTAL WOMENS CARE OF EAST TEXAS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-727-0110
Mailing Address - Street 1:126 MEDICAL DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-8506
Mailing Address - Country:US
Mailing Address - Phone:903-729-4000
Mailing Address - Fax:903-729-3600
Practice Address - Street 1:126 MEDICAL DR
Practice Address - Street 2:SUITE B
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-8506
Practice Address - Country:US
Practice Address - Phone:903-729-4000
Practice Address - Fax:903-729-3600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-17
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0090TMOtherBC/BS OF TEXAS
TX212117002Medicaid
TX212117002Medicaid