Provider Demographics
NPI:1518033554
Name:SOUTH SOUND WOMEN'S CENTER LLP
Entity Type:Organization
Organization Name:SOUTH SOUND WOMEN'S CENTER LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:N
Authorized Official - Last Name:HENEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-705-1259
Mailing Address - Street 1:3920 CAPITAL MALL DR SW
Mailing Address - Street 2:SUITE 400
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502
Mailing Address - Country:US
Mailing Address - Phone:360-705-1259
Mailing Address - Fax:360-705-2757
Practice Address - Street 1:3920 CAPITAL MALL DR SW
Practice Address - Street 2:SUITE 400
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502
Practice Address - Country:US
Practice Address - Phone:360-705-1259
Practice Address - Fax:360-705-2757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7075617Medicaid