Provider Demographics
NPI:1780683292
Name:WOMEN'S MEDICAL CENTER LLP
Entity Type:Organization
Organization Name:WOMEN'S MEDICAL CENTER LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-762-8055
Mailing Address - Street 1:2000 W 21ST ST
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-4087
Mailing Address - Country:US
Mailing Address - Phone:505-762-8055
Mailing Address - Fax:505-763-3351
Practice Address - Street 1:2000 W 21ST ST
Practice Address - Street 2:SUITE A-1
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-4087
Practice Address - Country:US
Practice Address - Phone:505-762-8055
Practice Address - Fax:505-763-3351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM8738207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMD25110Medicare UPIN
NMQ09588Medicare UPIN
NMS45403Medicare UPIN
NMF26884Medicare UPIN
NMD43091Medicare UPIN
NMP26486Medicare UPIN
NMD35474Medicare UPIN
NM400521084Medicare ID - Type UnspecifiedWOMEN'S MEDICAL CENTER