Basic Information
| Provider Information | |||||||||
| NPI: | 1144653239 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDCENTER GYN SERVICES PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7580 FANNIN ST | ||||||||
| Address2: | SUITE 335D | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770541900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136650404 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7580 FANNIN ST | ||||||||
| Address2: | SUITE 335D | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770541900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7136650404 | ||||||||
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| ProviderEnumerationDate: | 08/13/2013 | ||||||||
| LastUpdateDate: | 08/13/2013 | ||||||||
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| AuthorizedOfficialLastName: | FROMM | ||||||||
| AuthorizedOfficialFirstName: | GERI-LYNN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7136650404 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0201X | H5311 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology |
No ID Information.