1396783742 NPI number — WOMEN'S HEALTH AFFILIATES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396783742 NPI number — WOMEN'S HEALTH AFFILIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOMEN'S HEALTH AFFILIATES, INC.
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:
SIGNATURE HEALTHCARE WOMEN'S HEALTH AFFILIATES
Provider Other Organization Name Type Code:
3
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:
1396783742
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 847476
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02284-7476
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-565-0147
Provider Business Mailing Address Fax Number:
508-565-0157

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
680 CENTRE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROCKTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02302-3308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-941-7062
Provider Business Practice Location Address Fax Number:
508-941-6337
Provider Enumeration Date:
06/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MERLIN
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
508-941-7062

Provider Taxonomy Codes

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

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

  • Identifier: M16621 . This is a "BCBS GROUP #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9780246 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com