1114027315 NPI number — WOMENS HEALTH CENTER PLLC

Table of content: (NPI 1114027315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114027315 NPI number — WOMENS HEALTH CENTER PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOMENS HEALTH CENTER PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114027315
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1318 HARRISON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCCOMB
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39648-2830
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-684-2300
Provider Business Mailing Address Fax Number:
601-684-2360

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1318 HARRISON AVE
Provider Second Line Business Practice Location Address:
STE 500
Provider Business Practice Location Address City Name:
MCCOMB
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39648-2830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-684-2300
Provider Business Practice Location Address Fax Number:
601-684-2360
Provider Enumeration Date:
09/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HUBBS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
RAY
Authorized Official Title or Position:
SENIOR PARTNER
Authorized Official Telephone Number:
601-684-2300

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 434882043 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 438986798 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 08607 . This is a "STATE LICENSE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 00115244 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1320960 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 19007 . This is a "STATE LICENSE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 17612 . This is a "STATE LICENSE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 03402745 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03886877 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1043621 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1570591 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 435250008 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 00126201 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1074489 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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