Basic Information
| Provider Information | |||||||||
| NPI: | 1609882943 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TEXARKANA WOMEN'S CLINIC PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2604 ST MICHAEL DR | ||||||||
| Address2: | SUITE 410 | ||||||||
| City: | TEXARKANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036145430 | ||||||||
| FaxNumber: | 9036145464 | ||||||||
| Practice Location | |||||||||
| Address1: | 2604 ST MICHAEL DR | ||||||||
| Address2: | SUITE 410 | ||||||||
| City: | TEXARKANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036145430 | ||||||||
| FaxNumber: | 9036145464 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SHAFFER | ||||||||
| AuthorizedOfficialFirstName: | VERNON | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9036145430 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.