MEDICARE: WOMENS TOTAL CARE OF EAST TEXAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	J6274	TX
2	207VE0102X	Reproductive Endocrinology Physician	J6274	TX
3	207VG0400X	Gynecology Physician	J6274	TX
4	207VM0101X	Maternal & Fetal Medicine Physician	J6274	TX
5	207VX0000X	Obstetrics Physician	J6274	TX
6	207VX0201X	Gynecologic Oncology Physician	J6274	TX
7	2471B0102X	Bone Densitometry Radiologic Technologist	J6274	TX
8	2471S1302X	Sonography Radiologic Technologist	J6274	TX
9	363L00000X	Nurse Practitioner	J6274	TX
10	363LA2200X	Adult Health Nurse Practitioner	J6274	TX
11	363LF0000X	Family Nurse Practitioner	J6274	TX
12	363LP2300X	Primary Care Nurse Practitioner	J6274	TX
13	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	J6274	TX
14	364SW0102X	Women's Health Clinical Nurse Specialist	J6274	TX
15	207VC0200X	Critical Care Medicine (Obstetrics & Gynecology) Physician	J6274	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DG6694	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0025HZ	OTHER		BLUE CROSS & BLUE SHIELD

General Provider Information

NPI Number	:	1326018656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMENS TOTAL CARE OF EAST TEXAS

Provider Business Mailing Address
First Line	:	837 S FLEISHEL AVE
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-2017
Country	:	US
Telephone Number	:	903-939-2273
Fax Number	:	903-581-2137

Provider Business Practice Location Address
First Line	:	837 S FLEISHEL AVE
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-2017
Country	:	US
Telephone Number	:	903-939-2273
Fax Number	:	903-581-2137

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAMES LOUIS WASSON
Credential	:	MD
Telephone Number	:	903-939-2273

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	09/27/2023

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837 S FLEISHEL AVE
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1861783946 — RYLEIGH REBECCA YOUNG SMITH CPNP
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Practice Location Address:

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Directions to “WOMENS TOTAL CARE OF EAST TEXAS ” Practice Location

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