MEDICARE: SOUTHEAST TEXAS WOMEN'S HEALTH PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	N4270	TX

General Provider Information

NPI Number	:	1194047084
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST TEXAS WOMEN'S HEALTH PA

Provider Business Mailing Address
First Line	:	3141 SABA LN
Second Line	:
City	:	PORT NECHES
State	:	TX
Zip	:	77651-5421
Country	:	US
Telephone Number	:	409-722-9995
Fax Number	:

Provider Business Practice Location Address
First Line	:	3141 SABA LN
Second Line	:
City	:	PORT NECHES
State	:	TX
Zip	:	77651-5421
Country	:	US
Telephone Number	:	409-722-9995
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED AGENT
Name	:	DR. GEORGE T. BACKARDJIEV
Credential	:	MD
Telephone Number	:	409-722-9995

Provider Enumeration Date	:	02/19/2010
Last Update Date	:	06/04/2010

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