Provider Demographics
NPI:1164571139
Name:WOMENS HEALTH CENTER OF MACOMB INC
Entity Type:Organization
Organization Name:WOMENS HEALTH CENTER OF MACOMB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ECKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-833-5959
Mailing Address - Street 1:PO BOX 393
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-0393
Mailing Address - Country:US
Mailing Address - Phone:309-833-2868
Mailing Address - Fax:309-836-3779
Practice Address - Street 1:505 E GRANT ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-3352
Practice Address - Country:US
Practice Address - Phone:309-833-5959
Practice Address - Fax:309-833-4969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102265207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL059558OtherHEALTH ALLIANCE
IL5530096OtherBLUE CROSS BLUE SHIELD
IL036102265Medicaid
IL036102265Medicaid
ILH18602Medicare UPIN