Healthcare Provider Details

I. General information

NPI: 1699756452
Provider Name (Legal Business Name): NORTHEAST TEXAS WOMENS HEALTH P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 11/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 MULBERRY AVE SUITE 250
MOUNT PLEASANT TX
75455-2312
US

IV. Provider business mailing address

2015 MULBERRY AVE SUITE 250
MOUNT PLEASANT TX
75455-2312
US

V. Phone/Fax

Practice location:
  • Phone: 903-572-4664
  • Fax: 903-572-4647
Mailing address:
  • Phone: 903-572-4664
  • Fax: 903-572-4647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER N MASON
Title or Position: PHYSICIAN/PRESIDENT
Credential: MD
Phone: 903-572-4664