Provider Demographics
NPI:1316035199
Name:CENTER FOR WOMEN'S HEALTH CARE, LLC
Entity type:Organization
Organization Name:CENTER FOR WOMEN'S HEALTH CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DOWNING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-357-4980
Mailing Address - Street 1:3505 E MERIDIAN PARK LOOP STE 100
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7294
Mailing Address - Country:US
Mailing Address - Phone:907-357-4963
Mailing Address - Fax:907-357-1894
Practice Address - Street 1:3505 E MERIDIAN PARK LOOP STE 100
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-357-4963
Practice Address - Fax:907-357-1894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMDG041Medicaid
AK02D0975848OtherCLIA
AKK151206Medicare PIN