Provider Demographics
NPI:1679500672
Name:WOMEN'S HEALTH OF WESTERLY, LLC
Entity Type:Organization
Organization Name:WOMEN'S HEALTH OF WESTERLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/THE WESTERLY HOSPITAL
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:S
Authorized Official - Last Name:KINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-596-6000
Mailing Address - Street 1:45 WELLS STREET
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891
Mailing Address - Country:US
Mailing Address - Phone:401-348-0008
Mailing Address - Fax:401-348-3053
Practice Address - Street 1:45 WELLS STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891
Practice Address - Country:US
Practice Address - Phone:401-348-0008
Practice Address - Fax:401-348-3053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11114207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC02825Medicare PIN
RI169023222Medicare PIN