Provider Demographics
NPI:1447392774
Name:ASSOCIATES FOR WOMENS HEALTH OF SOUTHERN OREGON LLC
Entity Type:Organization
Organization Name:ASSOCIATES FOR WOMENS HEALTH OF SOUTHERN OREGON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:CARBONELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-773-1565
Mailing Address - Street 1:3190 STATE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8498
Mailing Address - Country:US
Mailing Address - Phone:541-773-1565
Mailing Address - Fax:541-773-1929
Practice Address - Street 1:3190 STATE ST STE 102
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8498
Practice Address - Country:US
Practice Address - Phone:541-773-1565
Practice Address - Fax:541-773-1929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR105909Medicare PIN