MEDICARE: NORTHEAST TEXAS WOMENS HEALTH P A

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	367A00000X	Advanced Practice Midwife
2	207V00000X	Obstetrics & Gynecology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DA9153	OTHER		RAIL ROAD 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	0076JY	OTHER	TX	BCBS
4	121107	OTHER		SUPERIOR HEALTH PLAN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699756452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST TEXAS WOMENS HEALTH P A

Provider Business Mailing Address
First Line	:	2015 MULBERRY AVE
Second Line	:	SUITE 250
City	:	MOUNT PLEASANT
State	:	TX
Zip	:	75455-2312
Country	:	US
Telephone Number	:	903-572-4664
Fax Number	:	903-572-4647

Provider Business Practice Location Address
First Line	:	2015 MULBERRY AVE
Second Line	:	SUITE 250
City	:	MOUNT PLEASANT
State	:	TX
Zip	:	75455-2312
Country	:	US
Telephone Number	:	903-572-4664
Fax Number	:	903-572-4647

Authorized Official
Title or Position	:	PHYSICIAN/PRESIDENT
Name	:	DR. CHRISTOPHER N MASON
Credential	:	MD
Telephone Number	:	903-572-4664

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	11/03/2015

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Directions to “NORTHEAST TEXAS WOMENS HEALTH P A ” Practice Location

Language	Start Address	Practice Location

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