Provider Demographics
NPI:1477834216
Name:WOMENCARE INC
Entity Type:Organization
Organization Name:WOMENCARE INC
Other - Org Name:FAMILYCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:COOK
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-757-6999
Mailing Address - Street 1:301 GREAT TEAYS BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-9552
Mailing Address - Country:US
Mailing Address - Phone:304-757-6999
Mailing Address - Fax:
Practice Address - Street 1:3280 WINFIELD RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:WV
Practice Address - Zip Code:25213-9636
Practice Address - Country:US
Practice Address - Phone:304-380-7728
Practice Address - Fax:304-586-1301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2023-01-13
Deactivation Date:2022-05-24
Deactivation Code:
Reactivation Date:2023-01-13
Provider Licenses
StateLicense IDTaxonomies
WV2257-5037261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810024459Medicaid
WV3810024459Medicaid
WVQ417580002Medicare PIN