1609204866 NPI number — SELECT WOMENS HEALTH PLLC

Table of content: (NPI 1609204866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609204866 NPI number — SELECT WOMENS HEALTH PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SELECT WOMENS HEALTH PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609204866
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23920 KATY FWY
Provider Second Line Business Mailing Address:
STE 460
Provider Business Mailing Address City Name:
KATY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77494-1341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-464-1845
Provider Business Mailing Address Fax Number:
281-392-5081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23920 KATY FWY
Provider Second Line Business Practice Location Address:
STE 460
Provider Business Practice Location Address City Name:
KATY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77494-1341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-464-1845
Provider Business Practice Location Address Fax Number:
281-392-5081
Provider Enumeration Date:
10/28/2013

Additional Information

Authorized Official

Authorized Official Last Name:
TAL
Authorized Official First Name:
JACOB
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
713-464-1845

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  F7630 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0078ZF . This is a "BCBS GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 099716503 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 332533YXXR . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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