Provider Demographics
NPI:1558445981
Name:WOMENS WELLNESS INSTITUTE PLLC
Entity Type:Organization
Organization Name:WOMENS WELLNESS INSTITUTE PLLC
Other - Org Name:THE WOMANS PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:URELAINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-482-4181
Mailing Address - Street 1:2401 16TH STREET
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-2123
Mailing Address - Country:US
Mailing Address - Phone:601-482-4181
Mailing Address - Fax:
Practice Address - Street 1:2401 16TH STREET
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-2123
Practice Address - Country:US
Practice Address - Phone:601-482-4181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207VG0400X, 207VX0000X
MSR876229367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS160000719Medicare PIN