Basic Information
| Provider Information | |||||||||
| NPI: | 1265189476 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOUSTON PHYSICIAN SPECIALISTS, LLC. | ||||||||
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| OtherOrganizationName: | HOUSTON PHYSICIANS FOR WOMEN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 WATSON BLVD | ||||||||
| Address2: | ATTN: PROVIDER ENROLLMENT | ||||||||
| City: | WARNER ROBINS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4783524306 | ||||||||
| FaxNumber: | 4789756652 | ||||||||
| Practice Location | |||||||||
| Address1: | 1021 N HOUSTON RD | ||||||||
| Address2: | |||||||||
| City: | WARNER ROBINS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310931505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4789229944 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2022 | ||||||||
| LastUpdateDate: | 03/08/2022 | ||||||||
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| AuthorizedOfficialLastName: | WHILDEN | ||||||||
| AuthorizedOfficialFirstName: | SEAN | ||||||||
| AuthorizedOfficialMiddleName: | STEVEN | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4785427959 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.