Provider Demographics
NPI:1760952576
Name:WOMENS CENTER FOR PELVIC WELLNESS, INC
Entity Type:Organization
Organization Name:WOMENS CENTER FOR PELVIC WELLNESS, INC
Other - Org Name:WOMEN'S CENTER FOR PELVIC WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:KIMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-535-0832
Mailing Address - Street 1:PO BOX 24682
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4497
Mailing Address - Country:US
Mailing Address - Phone:626-535-0832
Mailing Address - Fax:626-535-0842
Practice Address - Street 1:542 S FAIR OAKS AVE FL 2
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105
Practice Address - Country:US
Practice Address - Phone:626-535-0832
Practice Address - Fax:626-535-0842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-05
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive SurgeryGroup - Single Specialty