Healthcare Provider Details

I. General information

NPI: 1962720847
Provider Name (Legal Business Name): TOTAL WOMENS CARE OF EAST TEXAS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 MEDICAL DR SUITE B
PALESTINE TX
75801-8506
US

IV. Provider business mailing address

126 MEDICAL DR SUITE B
PALESTINE TX
75801-8506
US

V. Phone/Fax

Practice location:
  • Phone: 903-729-4000
  • Fax: 903-729-3600
Mailing address:
  • Phone: 903-729-4000
  • Fax: 903-729-3600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SANDRA WHITWORTH
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 903-727-0110