Healthcare Provider Details

I. General information

NPI: 1023406857
Provider Name (Legal Business Name): PARKFORD WOMENS CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/01/2015
Last Update Date: 01/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18124 GREAT BASIN AVE
PFLUGERVILLE TX
78660-5252
US

IV. Provider business mailing address

18124 GREAT BASIN AVE
PFLUGERVILLE TX
78660-5252
US

V. Phone/Fax

Practice location:
  • Phone: 737-210-9558
  • Fax:
Mailing address:
  • Phone: 737-210-9558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number716452
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number716452
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number716452
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number716452
License Number StateTX

VIII. Authorized Official

Name: MRS. BELINDA GAIL ELLIS
Title or Position: REGISTERED NURSE
Credential: RN BSN
Phone: 737-210-9558