Provider Demographics
NPI:1417064486
Name:WOMENS IMAGE CENTER
Entity Type:Organization
Organization Name:WOMENS IMAGE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:AFRAME
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
Authorized Official - Phone:978-660-9726
Mailing Address - Street 1:80 ERDMAN WAY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-1840
Mailing Address - Country:US
Mailing Address - Phone:978-534-0200
Mailing Address - Fax:978-534-0285
Practice Address - Street 1:80 ERDMAN WAY
Practice Address - Street 2:SUITE 204
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-1840
Practice Address - Country:US
Practice Address - Phone:978-534-0200
Practice Address - Fax:978-534-0285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA661328OtherHARVARD PILGRIM
MA806952OtherTUFLS
MA48757OtherFALLON
MA392054OtherBCBS
MA9544134OtherCIGNA
MA97447501OtherNETWORK HEALTH
MA0043661OtherNEIGHBORHOOD HEALTH PLAN
MA661328OtherHARVARD PILGRIM