Provider Demographics
NPI:1588661144
Name:WOMEN'S IMAGING AND WELLNESS, INC.
Entity Type:Organization
Organization Name:WOMEN'S IMAGING AND WELLNESS, INC.
Other - Org Name:SOLIS WOMEN'S HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:POLFREMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-398-4110
Mailing Address - Street 1:15601 DALLAS PARKWAY
Mailing Address - Street 2:STE. 500
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-6021
Mailing Address - Country:US
Mailing Address - Phone:469-398-4110
Mailing Address - Fax:
Practice Address - Street 1:5156 BLAZER PKWY
Practice Address - Street 2:STE 120
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-7318
Practice Address - Country:US
Practice Address - Phone:614-791-9355
Practice Address - Fax:614-791-2970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-G-02046-01261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH101212OtherMAMMOGRAPHY CERTIFICATION
OH2817241Medicaid
OH000000299853OtherANTHEM PIN
OH000000299853OtherANTHEM PIN
OHW09336081Medicare PIN