MEDICARE: DR. TERI LYNNE BAUMGARTNER M.D.

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	K6959	TX

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	8S2731	OTHER	TX	IND. BLUE CROSS BLUE SHIE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831194836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERI LYNNE BAUMGARTNER M.D.

Provider Business Mailing Address
First Line	:	115 MEDICAL CIR STE 103
Second Line	:
City	:	ATHENS
State	:	TX
Zip	:	75751-9004
Country	:	US
Telephone Number	:	903-677-8453
Fax Number	:	903-677-8454

Provider Business Practice Location Address
First Line	:	115 MEDICAL CIR STE 103
Second Line	:
City	:	ATHENS
State	:	TX
Zip	:	75751-9004
Country	:	US
Telephone Number	:	903-677-8453
Fax Number	:	903-677-8454

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	02/06/2012

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