=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265741755
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MADEWELL WOMAN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2010
-----------------------------------------------------
Last Update Date | 09/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2509 THOMAS AVE
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75201-2039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-220-0100
-----------------------------------------------------
Fax | 214-821-5415
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3310 LIVE OAK ST SUITE 210
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75204-6153
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-821-5400
-----------------------------------------------------
Fax | 214-821-5415
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. YOLANDA R. LAWSON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 214-821-5400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QB0400X
-----------------------------------------------------
Taxonomy Name | Birthing Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------