Provider Demographics
NPI:1306097829
Name:WOMEN'S CONTEMPORARY HEALTH CENTER, PLLC
Entity type:Organization
Organization Name:WOMEN'S CONTEMPORARY HEALTH CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOZAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-561-9191
Mailing Address - Street 1:6150 DIAMOND CENTRE CT
Mailing Address - Street 2:BUILDING 400
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4365
Mailing Address - Country:US
Mailing Address - Phone:239-561-9191
Mailing Address - Fax:239-561-9188
Practice Address - Street 1:6150 DIAMOND CENTRE CT
Practice Address - Street 2:BUILDING 400
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4365
Practice Address - Country:US
Practice Address - Phone:239-561-9191
Practice Address - Fax:239-561-9188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0045181174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041920600Medicaid
FL041920600Medicaid