Provider Demographics
NPI:1861563777
Name:OB GYN ASSOCIATES OF HENDERSON LLP
Entity type:Organization
Organization Name:OB GYN ASSOCIATES OF HENDERSON LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-655-8851
Mailing Address - Street 1:105 ZEID BLVD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75652
Mailing Address - Country:US
Mailing Address - Phone:903-655-8851
Mailing Address - Fax:903-657-1549
Practice Address - Street 1:105 ZEID BLVD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75652
Practice Address - Country:US
Practice Address - Phone:903-655-8851
Practice Address - Fax:903-657-1549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176849101Medicaid
TX176849101Medicaid