Provider Demographics
NPI:1194277426
Name:WOMEN'S MEDICAL & GYN CENTRE, LLC
Entity type:Organization
Organization Name:WOMEN'S MEDICAL & GYN CENTRE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:HIRAM
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-758-1010
Mailing Address - Street 1:2055 HIGHWAY 95
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-6004
Mailing Address - Country:US
Mailing Address - Phone:928-758-1010
Mailing Address - Fax:928-758-1428
Practice Address - Street 1:2055 HIGHWAY 95
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-6004
Practice Address - Country:US
Practice Address - Phone:928-758-1010
Practice Address - Fax:928-758-1428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-03
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21702305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZF67902Medicare UPIN