Provider Demographics
NPI:1700214426
Name:PREMIER WOMEN'S HEALTH, PLLC
Entity Type:Organization
Organization Name:PREMIER WOMEN'S HEALTH, PLLC
Other - Org Name:PREMIER WOMEN'S HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRINGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-206-1905
Mailing Address - Street 1:PO BOX 7353
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39506-7353
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14231 SEAWAY RD
Practice Address - Street 2:#3004
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4628
Practice Address - Country:US
Practice Address - Phone:228-206-1905
Practice Address - Fax:228-206-1917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-15
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18054174400000X
MS13792174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F50263Medicare UPIN
H87490Medicare UPIN