MEDICARE: OBSTETRICAL AND GYNECOLOGICAL ASSOCIATES, PLLC

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	207VE0102X	Reproductive Endocrinology Physician		TX
2	207VG0400X	Gynecology Physician		TX
3	2085R0202X	Diagnostic Radiology Physician		TX
4	2085U0001X	Diagnostic Ultrasound Physician		TX
5	291U00000X	Clinical Medical Laboratory		TX
6	207V00000X	Obstetrics & Gynecology Physician	D9508	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CN9938	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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891797999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OBSTETRICAL AND GYNECOLOGICAL ASSOCIATES, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 4048
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77210-4048
Country	:	US
Telephone Number	:	713-512-7000
Fax Number	:	713-512-7082

Provider Business Practice Location Address
First Line	:	7900 FANNIN ST
Second Line	:	SUITE 4000
City	:	HOUSTON
State	:	TX
Zip	:	77054-2934
Country	:	US
Telephone Number	:	713-512-7000
Fax Number	:	713-512-7082

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	RORY PENA
Credential	:
Telephone Number	:	713-512-7027

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	04/22/2014

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Directions to “OBSTETRICAL AND GYNECOLOGICAL ASSOCIATES, PLLC ” Practice Location

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