Provider Demographics
NPI:1497788681
Name:BELLEFONTAINE WOMENS HEALTH CARE MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:BELLEFONTAINE WOMENS HEALTH CARE MEDICAL GROUP, INC.
Other - Org Name:GREGORY MILLER, M.D., PRESIDENT
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-796-3153
Mailing Address - Street 1:50 ALESSANDRO PL
Mailing Address - Street 2:310
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3149
Mailing Address - Country:US
Mailing Address - Phone:626-796-3153
Mailing Address - Fax:626-796-6495
Practice Address - Street 1:50 ALESSANDRO PL
Practice Address - Street 2:310
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3149
Practice Address - Country:US
Practice Address - Phone:626-796-3153
Practice Address - Fax:626-796-6495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG16108174400000X
CAA82969174400000X
CAG9851174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9851OtherMEDICAL LICENSE CHARLES B
CAA39706Medicare UPIN
CAI42793Medicare UPIN