1013268747 NPI number — WHBOUTIQUE INC.

Table of content: QUYEN THI DO UONG (NPI 1164993390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013268747 NPI number — WHBOUTIQUE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHBOUTIQUE INC.
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:
WOMEN'S HEALTH BOUTIQUE
Provider Other Organization Name Type Code:
3
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:
1013268747
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
605 N 6TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONGVIEW
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75601-6606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-758-9904
Provider Business Mailing Address Fax Number:
903-236-9786

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3115 W PARKER RD
Provider Second Line Business Practice Location Address:
SUITE 270
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75023-8129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-985-4477
Provider Business Practice Location Address Fax Number:
972-596-3898
Provider Enumeration Date:
09/20/2012

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
VICKI
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER / MANAGER
Authorized Official Telephone Number:
903-758-9904

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  1000993 , 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: 533962 . This is a "BCBSTX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 3495830-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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