Provider Demographics
NPI:1033207766
Name:ALBEMARLE WOMENS CLINIC PA
Entity Type:Organization
Organization Name:ALBEMARLE WOMENS CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR BUSINESS OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-982-8112
Mailing Address - Street 1:1000 N 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-3420
Mailing Address - Country:US
Mailing Address - Phone:704-982-8112
Mailing Address - Fax:704-982-8097
Practice Address - Street 1:1000 N 5TH STREET
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3420
Practice Address - Country:US
Practice Address - Phone:704-982-8112
Practice Address - Fax:704-982-8097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39651207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901032Medicaid
NC01032OtherBLUE CROSS BLUE SHIELD
NC230331Medicare ID - Type Unspecified
NC8901032Medicaid