Provider Demographics
NPI:1558582338
Name:PROFESSIONALS FOR WOMENS HEALTH
Entity Type:Organization
Organization Name:PROFESSIONALS FOR WOMENS HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-268-8800
Mailing Address - Street 1:94 N HIGH ST
Mailing Address - Street 2:SUITE 290
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1169
Mailing Address - Country:US
Mailing Address - Phone:614-268-8800
Mailing Address - Fax:614-268-8249
Practice Address - Street 1:94 N HIGH ST
Practice Address - Street 2:SUITE 290
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1169
Practice Address - Country:US
Practice Address - Phone:614-268-8800
Practice Address - Fax:614-268-8249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0962696Medicaid
OHPR9257433Medicare ID - Type Unspecified