Provider Demographics
NPI:1538113436
Name:WIH FACULTY PRACTICE, INC
Entity Type:Organization
Organization Name:WIH FACULTY PRACTICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-274-1100
Mailing Address - Street 1:101 DUDLEY STREET
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-2499
Mailing Address - Country:US
Mailing Address - Phone:401-274-1100
Mailing Address - Fax:401-453-7666
Practice Address - Street 1:67 BRIGHAM STREET
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740
Practice Address - Country:US
Practice Address - Phone:401-274-1100
Practice Address - Fax:401-453-7666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM21668Medicare ID - Type Unspecified