Provider Demographics
NPI:1689838120
Name:WOMEN'S HEALTHSOURCE, L.L.C.
Entity Type:Organization
Organization Name:WOMEN'S HEALTHSOURCE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:318-325-1731
Mailing Address - Street 1:410 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7445
Mailing Address - Country:US
Mailing Address - Phone:318-325-1731
Mailing Address - Fax:318-325-5636
Practice Address - Street 1:410 WOOD ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7445
Practice Address - Country:US
Practice Address - Phone:318-325-1731
Practice Address - Fax:318-325-5636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD012257207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty