Provider Demographics
NPI:1588937734
Name:CREEKSIDE WOMENS CENTER
Entity type:Organization
Organization Name:CREEKSIDE WOMENS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:NEWTON
Authorized Official - Last Name:PLEASANT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:832-717-0074
Mailing Address - Street 1:2034 CREEKSIDE LANDING DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-3982
Mailing Address - Country:US
Mailing Address - Phone:919-303-8077
Mailing Address - Fax:919-303-8073
Practice Address - Street 1:2034 CREEKSIDE LANDING DR
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-3982
Practice Address - Country:US
Practice Address - Phone:919-363-8011
Practice Address - Fax:919-363-2411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-20
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400974207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty