Provider Demographics
NPI:1073643722
Name:WOMENS HEALTH CENTER
Entity Type:Organization
Organization Name:WOMENS HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OBSTETRICS GYNECOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-356-9500
Mailing Address - Street 1:615 BIENVILLE ST
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-5730
Mailing Address - Country:US
Mailing Address - Phone:318-356-9500
Mailing Address - Fax:318-356-9588
Practice Address - Street 1:615 BIENVILLE ST
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-5730
Practice Address - Country:US
Practice Address - Phone:318-356-9500
Practice Address - Fax:318-356-9588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1135OR174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1452807Medicaid