Healthcare Provider Details

I. General information

NPI: 1205903564
Provider Name (Legal Business Name): DEPARTMENT OF STATE HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 N BIG SPRING ST STE 300 HSR 9/10 ATTN: BEKI HAMMONTREE
MIDLAND TX
79705-7649
US

IV. Provider business mailing address

2301 N BIG SPRING ST STE 300 HSR 9/10 ATTN: BEKI HAMMONTREE
MIDLAND TX
79705-4534
US

V. Phone/Fax

Practice location:
  • Phone: 432-571-4142
  • Fax: 432-571-4153
Mailing address:
  • Phone: 432-571-4142
  • Fax: 432-571-4153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number StateTX

VIII. Authorized Official

Name: DR. MARY A ANDERSON
Title or Position: REGIONAL DIRECTOR
Credential: M.D., M.P.H.
Phone: 915-834-7680