Provider Demographics
NPI:1003343864
Name:MEN & WOMENS PREMIER HEALTH SOLUTIONS PA
Entity Type:Organization
Organization Name:MEN & WOMENS PREMIER HEALTH SOLUTIONS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-333-5488
Mailing Address - Street 1:3410 E JOHNSON AVE STE T
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-1876
Mailing Address - Country:US
Mailing Address - Phone:870-333-5488
Mailing Address - Fax:870-333-5442
Practice Address - Street 1:3410 E JOHNSON AVE STE T
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-1876
Practice Address - Country:US
Practice Address - Phone:870-333-5488
Practice Address - Fax:870-333-5442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNE-2900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty