Provider Demographics
NPI:1689026932
Name:KEYSTONE WOMENS CENTER LLC
Entity Type:Organization
Organization Name:KEYSTONE WOMENS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SORENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-431-1152
Mailing Address - Street 1:2213 BROTHERS RD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-6993
Mailing Address - Country:US
Mailing Address - Phone:505-466-5433
Mailing Address - Fax:505-466-5436
Practice Address - Street 1:2213 BROTHERS RD
Practice Address - Street 2:SUITE 700
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6993
Practice Address - Country:US
Practice Address - Phone:505-466-5433
Practice Address - Fax:505-466-5436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2011-0411207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty