Provider Demographics
NPI:1609882943
Name:TEXARKANA WOMEN'S CLINIC PA
Entity type:Organization
Organization Name:TEXARKANA WOMEN'S CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHAFFER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:903-614-5430
Mailing Address - Street 1:2604 ST MICHAEL DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503
Mailing Address - Country:US
Mailing Address - Phone:903-614-5430
Mailing Address - Fax:903-614-5464
Practice Address - Street 1:2604 ST MICHAEL DR
Practice Address - Street 2:SUITE 410
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503
Practice Address - Country:US
Practice Address - Phone:903-614-5430
Practice Address - Fax:903-614-5464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00007RMedicare ID - Type Unspecified