MEDICARE: WOMEN'S CLINIC OF DIMMIT & ZAVALA,P.A.

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00212R	OTHER	TX	MEDICARE GROUP NUMBER
4	673856	OTHER	TX	MEDICARE PART A RURAL HEALTH
5	8478M0	OTHER	TX	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780629220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMEN'S CLINIC OF DIMMIT & ZAVALA,P.A.

Provider Business Mailing Address
First Line	:	706 HOSPITAL DRIVE
Second Line	:
City	:	CARRIZO SPRINGS
State	:	TX
Zip	:	78834-3836
Country	:	US
Telephone Number	:	830-876-9625
Fax Number	:	830-876-5752

Provider Business Practice Location Address
First Line	:	706 HOSPITAL DRIVE
Second Line	:
City	:	CARRIZO SPRINGS
State	:	TX
Zip	:	78834-3836
Country	:	US
Telephone Number	:	830-876-9625
Fax Number	:	830-876-5752

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DR. MICHEAL ANTHONY BUTLER
Credential	:	MD
Telephone Number	:	830-876-9625

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	03/05/2009

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