Provider Demographics
NPI:1386691921
Name:CANTON WOMEN'S CENTER INC
Entity type:Organization
Organization Name:CANTON WOMEN'S CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:RAUL
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-966-9090
Mailing Address - Street 1:6555 FRANK AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-7265
Mailing Address - Country:US
Mailing Address - Phone:330-966-9090
Mailing Address - Fax:330-966-9030
Practice Address - Street 1:6555 FRANK AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7265
Practice Address - Country:US
Practice Address - Phone:330-966-9090
Practice Address - Fax:330-966-9030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2274716OtherAETNA
=========027OtherCARE SOURCE
2274716OtherAETNA