Provider Demographics
NPI:1417079831
Name:MEDICAL CENTER WOMEN'S HEALTH, INC
Entity Type:Organization
Organization Name:MEDICAL CENTER WOMEN'S HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BOBBIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DESPER
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:540-245-7007
Mailing Address - Street 1:70 MEDICAL CENTER CIR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2273
Mailing Address - Country:US
Mailing Address - Phone:540-245-7007
Mailing Address - Fax:540-245-7009
Practice Address - Street 1:70 MEDICAL CENTER CIR
Practice Address - Street 2:SUITE 202
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2273
Practice Address - Country:US
Practice Address - Phone:540-245-7007
Practice Address - Fax:540-245-7009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-05
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048669207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101048669OtherSTATE MD LICENSE
VA0101048669OtherSTATE MD LICENSE