Provider Demographics
NPI:1659525335
Name:WOMEN'S PELVIC SPECIALTY CARE
Entity Type:Organization
Organization Name:WOMEN'S PELVIC SPECIALTY CARE
Other - Org Name:DOROTHY KAMMERER-DOAK MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:NAOMI
Authorized Official - Last Name:KAMMERER-DOAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-888-0443
Mailing Address - Street 1:4705 MONTGOMERY BLVD NE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1226
Mailing Address - Country:US
Mailing Address - Phone:505-899-0443
Mailing Address - Fax:505-888-1398
Practice Address - Street 1:4705 MONTGOMERY BLVD NE
Practice Address - Street 2:SUITE 201
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1226
Practice Address - Country:US
Practice Address - Phone:505-899-0443
Practice Address - Fax:505-888-1398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-08
Last Update Date:2008-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM93-295261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM320019Medicare PIN