Provider Demographics
NPI:1164415766
Name:WOMENS CARE CENTER OF ERIE COUNTY INC
Entity Type:Organization
Organization Name:WOMENS CARE CENTER OF ERIE COUNTY INC
Other - Org Name:WOMENS CARE CENTER MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:NEWPORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-836-7505
Mailing Address - Street 1:4402 PEACH ST
Mailing Address - Street 2:STE 302
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-1358
Mailing Address - Country:US
Mailing Address - Phone:814-866-2010
Mailing Address - Fax:814-868-3420
Practice Address - Street 1:4402 PEACH ST
Practice Address - Street 2:STE 302
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-1358
Practice Address - Country:US
Practice Address - Phone:814-866-2010
Practice Address - Fax:814-868-3420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042517E207V00000X
261Q00000X
PASP002262G363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Not Answered363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009102140001Medicaid