Provider Demographics
NPI:1699858555
Name:PHOENIX WOMEN'S MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:PHOENIX WOMEN'S MEDICAL GROUP, INC.
Other - Org Name:PALM SPRINGS WOMEN'S HEALTHCARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:V
Authorized Official - Last Name:COOPER VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-320-1805
Mailing Address - Street 1:555 E TACHEVAH DR
Mailing Address - Street 2:SUITE #2E-103
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-5764
Mailing Address - Country:US
Mailing Address - Phone:760-320-1805
Mailing Address - Fax:760-416-9301
Practice Address - Street 1:555 E TACHEVAH DR
Practice Address - Street 2:#2E-103
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-5764
Practice Address - Country:US
Practice Address - Phone:760-320-1805
Practice Address - Fax:760-416-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87941207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0103420Medicaid