Basic Information
| Provider Information | |||||||||
| NPI: | 1154315802 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOMEN PARTNERS IN HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1305 W 34TH ST | ||||||||
| Address2: | SUITE 308 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124598082 | ||||||||
| FaxNumber: | 5124212010 | ||||||||
| Practice Location | |||||||||
| Address1: | 1305 W 34TH ST | ||||||||
| Address2: | SUITE 308 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124598082 | ||||||||
| FaxNumber: | 5124212010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2005 | ||||||||
| LastUpdateDate: | 10/28/2011 | ||||||||
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| AuthorizedOfficialLastName: | WINDHAM | ||||||||
| AuthorizedOfficialFirstName: | RICK | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5122796710 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0001X | 710924 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 094063701 | 05 | TX | MEDICAID |