Provider Demographics
NPI:1669664926
Name:ADVANCED WOMENS HEALTHCARE CENTER, LLC
Entity Type:Organization
Organization Name:ADVANCED WOMENS HEALTHCARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOEDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:920-748-0550
Mailing Address - Street 1:933 NEWBURY ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RIPON
Mailing Address - State:WI
Mailing Address - Zip Code:54971-1730
Mailing Address - Country:US
Mailing Address - Phone:920-748-0550
Mailing Address - Fax:920-748-0555
Practice Address - Street 1:933 NEWBURY ST
Practice Address - Street 2:SUITE 102
Practice Address - City:RIPON
Practice Address - State:WI
Practice Address - Zip Code:54971-1730
Practice Address - Country:US
Practice Address - Phone:920-748-0550
Practice Address - Fax:920-748-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31521-020207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIF55681Medicare UPIN