Provider Demographics
NPI:1770648636
Name:HOLLY K VIGIL DBA A WOMAN'S PLACE
Entity Type:Organization
Organization Name:HOLLY K VIGIL DBA A WOMAN'S PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BERMINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-233-8353
Mailing Address - Street 1:1350 N RIM DRIVE
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001
Mailing Address - Country:US
Mailing Address - Phone:928-779-9250
Mailing Address - Fax:928-213-1381
Practice Address - Street 1:1350 N RIM DRIVE
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001
Practice Address - Country:US
Practice Address - Phone:928-779-9250
Practice Address - Fax:928-213-1381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1205817251OtherPROVIDER NPI
AZ1780672006OtherPROVIDER NPI
AZ17800867603OtherPROVIDER NPI
AZ1780672089OtherPROVIDER NPI
AZ17800857984OtherPROVIDER NPI
AZ1891783197OtherPROVIDER NPI