Provider Demographics
NPI:1649384223
Name:PROFESSIONALS FOR WOMENS HEALTH INC
Entity Type:Organization
Organization Name:PROFESSIONALS FOR WOMENS HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
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 1:921B JASONWAY AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-2330
Mailing Address - Country:US
Mailing Address - Phone:614-268-8800
Mailing Address - Fax:614-447-8876
Practice Address - Street 1:921B JASONWAY AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-2330
Practice Address - Country:US
Practice Address - Phone:614-268-8800
Practice Address - Fax:614-447-8876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2009-10-27
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
OHPR9257431Medicare ID - Type UnspecifiedGROUP NUMBER