1609204866 NPI number — SELECT WOMENS HEALTH PLLC

Table of Contents

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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