Basic Information
| Provider Information | |||||||||
| NPI: | 1114027315 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOMENS HEALTH CENTER PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1318 HARRISON AVE | ||||||||
| Address2: | |||||||||
| City: | MCCOMB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 396482830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016842300 | ||||||||
| FaxNumber: | 6016842360 | ||||||||
| Practice Location | |||||||||
| Address1: | 1318 HARRISON AVE | ||||||||
| Address2: | STE 500 | ||||||||
| City: | MCCOMB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 396482830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016842300 | ||||||||
| FaxNumber: | 6016842360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 01/18/2011 | ||||||||
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| AuthorizedOfficialLastName: | HUBBS | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | RAY | ||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 6016842300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 434882043 | 01 | MS | BLUE CROSS BLUE SHIELD | OTHER | 438986798 | 01 | MS | BLUE CROSS BLUE SHIELD | OTHER | 08607 | 01 | MS | STATE LICENSE | OTHER | 00115244 | 05 | MS | MEDICAID | 1320960 | 05 | LA | MEDICAID | 19007 | 01 | MS | STATE LICENSE | OTHER | AH9068708 | 01 | MS | DEA | OTHER | BR7763027 | 01 | MS | DEA | OTHER | 17612 | 01 | MS | STATE LICENSE | OTHER | 03402745 | 05 | MS | MEDICAID | 03886877 | 05 | MS | MEDICAID | 1043621 | 05 | LA | MEDICAID | 1570591 | 05 | LA | MEDICAID | 435250008 | 01 | MS | BLUE CROSS BLUE SHIELD | OTHER | 00126201 | 05 | MS | MEDICAID | 1074489 | 05 | LA | MEDICAID | FT1769477 | 01 | MS | DEA | OTHER |