Provider Demographics
NPI:1508099193
Name:COMPASSIONATE WOMENS HEALTHCARE
Entity Type:Organization
Organization Name:COMPASSIONATE WOMENS HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FROST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-777-2550
Mailing Address - Street 1:22050 GREATER MACK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-2388
Mailing Address - Country:US
Mailing Address - Phone:586-777-2550
Mailing Address - Fax:586-777-2447
Practice Address - Street 1:22050 GREATER MACK AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-2388
Practice Address - Country:US
Practice Address - Phone:586-777-2550
Practice Address - Fax:586-777-2447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083979207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty