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General NPI Number Information
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NPI Number | 1043526262
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Entity Type | Organization
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Legal Business Name | SPECIALIZED WOMENS HEALTHCARE PLLC
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Dates
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Enumeration Date | 08/25/2010
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Last Update Date | 01/14/2011
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Provider Practice Location Address
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Address Line | 3804 W 15TH ST SUITE 140
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City | PLANO
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State | TX
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Zip | 75075-4752
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Country | US
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Telephone | 469-326-1600
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Fax | 469-326-1608
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Provider Business Mailing Address
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Address Line | 3804 W 15TH ST SUITE 140
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City | PLANO
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State | TX
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Zip | 75075-4752
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Country | US
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Telephone | 469-326-1600
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Fax | 469-326-1608
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JACKIE L LANE
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Credential | CMOM
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Telephone | 469-326-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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