Provider Demographics
NPI:1487887071
Name:TEXAS MATERNAL FETAL MEDICINE, PLLC
Entity type:Organization
Organization Name:TEXAS MATERNAL FETAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-401-9807
Mailing Address - Street 1:475 ELM ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3762
Mailing Address - Country:US
Mailing Address - Phone:214-222-3571
Mailing Address - Fax:214-222-3601
Practice Address - Street 1:475 ELM ST
Practice Address - Street 2:SUITE 203
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3762
Practice Address - Country:US
Practice Address - Phone:214-222-3571
Practice Address - Fax:214-222-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-28
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2097941-01Medicaid
TX2097941-01Medicaid