Provider Demographics
NPI:1255318648
Name:FREMONT WOMEN'S HEALTH, LLC
Entity Type:Organization
Organization Name:FREMONT WOMEN'S HEALTH, LLC
Other - Org Name:FREMONT WOMENS HEALTH CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:GREG
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-671-6800
Mailing Address - Street 1:PO BOX 612
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89125-0612
Mailing Address - Country:US
Mailing Address - Phone:702-671-6800
Mailing Address - Fax:702-671-6855
Practice Address - Street 1:3196 S MARYLAND PKWY
Practice Address - Street 2:SUITE 303
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2305
Practice Address - Country:US
Practice Address - Phone:702-383-2919
Practice Address - Fax:702-383-2886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100501006Medicaid
NVBA909Medicare PIN
NV100501006Medicaid
NVV37629Medicare PIN