Basic Information
| Provider Information | |||||||||
| NPI: | 1154451474 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPLETE HEALTHCARE FOR WOMEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1397 MEDICAL PARK BLVD | ||||||||
| Address2: | SUITE 360 | ||||||||
| City: | WELLINGTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334143186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617920050 | ||||||||
| FaxNumber: | 5617920048 | ||||||||
| Practice Location | |||||||||
| Address1: | 1397 MEDICAL PARK BLVD | ||||||||
| Address2: | SUITE 360 | ||||||||
| City: | WELLINGTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334143186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617920050 | ||||||||
| FaxNumber: | 5617920048 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 01/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | BROWN GRAHAM | ||||||||
| AuthorizedOfficialFirstName: | COLETTE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAM | ||||||||
| AuthorizedOfficialTelephone: | 5617920050 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COMPLETE HEALTHCARE FOR WOMEN | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 71561 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.