Provider Demographics
NPI:1124257209
Name:WOMENS HEALTHCARE CENTER LLC
Entity type:Organization
Organization Name:WOMENS HEALTHCARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:L
Authorized Official - Last Name:VINSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:334-222-1583
Mailing Address - Street 1:215 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-5354
Mailing Address - Country:US
Mailing Address - Phone:334-222-1583
Mailing Address - Fax:334-222-1573
Practice Address - Street 1:215 MEDICAL PARK DR
Practice Address - Street 2:SUITE 1
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-5354
Practice Address - Country:US
Practice Address - Phone:334-222-1583
Practice Address - Fax:334-222-1573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1061816363L00000X
ALDO833207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPENDINGMedicaid
ALPENDINGMedicaid