Provider Demographics
NPI:1003418229
Name:WILLOW WOMEN'S HEALTH, PLLC
Entity Type:Organization
Organization Name:WILLOW WOMEN'S HEALTH, PLLC
Other - Org Name:WILLOW WOMEN'S HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHRUTI
Authorized Official - Middle Name:
Authorized Official - Last Name:BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-470-7918
Mailing Address - Street 1:2840 LEGACY DR STE 400
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-6055
Mailing Address - Country:US
Mailing Address - Phone:469-476-5623
Mailing Address - Fax:
Practice Address - Street 1:712 N WASHINGTON AVE STE 250
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1631
Practice Address - Country:US
Practice Address - Phone:806-470-7918
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-12
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty