Provider Demographics
NPI:1285660761
Name:WOMENS PRIMARY CARE
Entity Type:Organization
Organization Name:WOMENS PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:THEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-871-0301
Mailing Address - Street 1:1617 RONALD DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6224
Mailing Address - Country:US
Mailing Address - Phone:919-871-0301
Mailing Address - Fax:919-871-0410
Practice Address - Street 1:1617 RONALD DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6224
Practice Address - Country:US
Practice Address - Phone:919-871-0301
Practice Address - Fax:919-871-0410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96-01343174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8910326Medicaid
NC2235145AMedicare ID - Type Unspecified
NC8910326Medicaid