Provider Demographics
NPI:1174600886
Name:GUADALUPE VALLEY WOMEN'S HEALTH CARE CENTER, PA
Entity type:Organization
Organization Name:GUADALUPE VALLEY WOMEN'S HEALTH CARE CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MANNEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-372-0600
Mailing Address - Street 1:1255 ASHBY ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5118
Mailing Address - Country:US
Mailing Address - Phone:830-372-0600
Mailing Address - Fax:830-372-0602
Practice Address - Street 1:1255 ASHBY ST
Practice Address - Street 2:SUITE G
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5118
Practice Address - Country:US
Practice Address - Phone:830-372-0600
Practice Address - Fax:830-372-0602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6901207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150998601Medicaid
TX00588NMedicare PIN