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General NPI Number Information
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NPI Number | 1851611933
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Entity Type | Organization
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Legal Business Name | ADVANCED WOMENS HEALTHCARE OF WAXAHACHIE PLLC
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Dates
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Enumeration Date | 06/10/2010
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Last Update Date | 03/07/2019
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Provider Practice Location Address
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Address Line | 2001 BATES DR STE 200
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City | WAXAHACHIE
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State | TX
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Zip | 75167-4828
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Country | US
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Telephone | 469-570-7001
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Fax | 469-570-7002
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Provider Business Mailing Address
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Address Line | 2001 BATES DR STE 200
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City | WAXAHACHIE
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State | TX
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Zip | 75167-4828
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Country | US
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Telephone | 469-570-7001
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Fax | 469-570-7002
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TRACY LEE GLASS
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Credential | D.O.
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Telephone | 325-437-1590
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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 | TX
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 782340
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | N1649
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License Number State | TX
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