Provider Demographics
NPI:1609064435
Name:ADVANCED WOMEN'S HEALTHCARE, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ADVANCED WOMEN'S HEALTHCARE, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT & CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGON
Authorized Official - Suffix:
Authorized Official - Credentials:NP & CNM
Authorized Official - Phone:760-327-7900
Mailing Address - Street 1:1100 NORTH PALM CANYON DRIVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4426
Mailing Address - Country:US
Mailing Address - Phone:760-327-7900
Mailing Address - Fax:760-327-7905
Practice Address - Street 1:79200 CORPORATE CENTER DR
Practice Address - Street 2:SUITE 201
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-7245
Practice Address - Country:US
Practice Address - Phone:760-564-7900
Practice Address - Fax:760-327-7905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207V00000X
CAA86905207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0101242Medicaid
CAZZZ27958ZMedicare UPIN
CAGR0101242Medicaid