Provider Demographics
NPI:1316171309
Name:HENRICO WOMEN'S HEALTH PC
Entity type:Organization
Organization Name:HENRICO WOMEN'S HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-282-7171
Mailing Address - Street 1:7605 FOREST AVE
Mailing Address - Street 2:SUITE 316
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4938
Mailing Address - Country:US
Mailing Address - Phone:804-282-0044
Mailing Address - Fax:804-287-4317
Practice Address - Street 1:7605 FOREST AVE
Practice Address - Street 2:SUITE 316
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4938
Practice Address - Country:US
Practice Address - Phone:804-282-0044
Practice Address - Fax:804-287-4317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035382207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6214771Medicaid
VA160001695Medicare PIN
VA6214771Medicaid