Basic Information
| Provider Information | |||||||||
| NPI: | 1689625998 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH CENTRAL WOMENS HEALTH PARTNERS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4541 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | MC KINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725428884 | ||||||||
| FaxNumber: | 9725424056 | ||||||||
| Practice Location | |||||||||
| Address1: | 4541 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | MC KINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725428884 | ||||||||
| FaxNumber: | 9725424056 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BANKS | ||||||||
| AuthorizedOfficialFirstName: | TRACEY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 9725428884 | ||||||||
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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 | 207V00000X | K7992 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 172S97001 | 05 | TX | MEDICAID |