Provider Demographics
NPI:1962914119
Name:WHOLE WOMAN'S HEALTH ALLIANCE
Entity type:Organization
Organization Name:WHOLE WOMAN'S HEALTH ALLIANCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-422-2061
Mailing Address - Street 1:1001 E MARKET ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5381
Mailing Address - Country:US
Mailing Address - Phone:434-202-8818
Mailing Address - Fax:
Practice Address - Street 1:3511 LINCOLN WAY W
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-1411
Practice Address - Country:US
Practice Address - Phone:512-835-6858
Practice Address - Fax:888-724-3239
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHOLE WOMAN'S HEALTH ALLIANCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-27
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID#