Provider Demographics
NPI:1831294537
Name:ADVANCED WOMEN'S HEALTHCARE IN OBSTETRICS & GYNECOLOGY PLLC
Entity Type:Organization
Organization Name:ADVANCED WOMEN'S HEALTHCARE IN OBSTETRICS & GYNECOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SOULE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-561-2216
Mailing Address - Street 1:8 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-3420
Mailing Address - Country:US
Mailing Address - Phone:518-563-8880
Mailing Address - Fax:518-562-1077
Practice Address - Street 1:8 BROAD ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-3420
Practice Address - Country:US
Practice Address - Phone:518-563-8880
Practice Address - Fax:518-562-1077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02997639Medicaid
NYAA0456Medicare ID - Type Unspecified