Provider Demographics
NPI:1750639795
Name:GREENFIELD WOMEN'S HEALTH CENTER LLC
Entity Type:Organization
Organization Name:GREENFIELD WOMEN'S HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT OF LLC
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:413-773-5483
Mailing Address - Street 1:5 PARK STREET
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301
Mailing Address - Country:US
Mailing Address - Phone:413-773-5483
Mailing Address - Fax:413-773-5489
Practice Address - Street 1:5 PARK STREET
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301
Practice Address - Country:US
Practice Address - Phone:413-773-5483
Practice Address - Fax:413-773-5489
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREENFIELD WOMEN'S HEALTH CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA28664207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty