Provider Demographics
NPI:1053450361
Name:WOODLAND WOMEN'S SERVICES, L.L.C.
Entity Type:Organization
Organization Name:WOODLAND WOMEN'S SERVICES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:B
Authorized Official - Last Name:FEINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-653-0048
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:NORTH GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06060-0151
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21 WOODLAND ST STE 112
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-4318
Practice Address - Country:US
Practice Address - Phone:860-278-7998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT50WOODWOMCT01OtherANTHEM GROUP PROVIDER NUM
CTC02523Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER