Provider Demographics
NPI:1932283686
Name:PWC II
Entity Type:Organization
Organization Name:PWC II
Other - Org Name:PRESCOTT WOMEN'S CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:OHANESIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-778-4300
Mailing Address - Street 1:919 12TH PL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-1433
Mailing Address - Country:US
Mailing Address - Phone:928-778-4300
Mailing Address - Fax:928-771-0920
Practice Address - Street 1:919 12TH PL
Practice Address - Street 2:SUITE 1
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1433
Practice Address - Country:US
Practice Address - Phone:928-778-4300
Practice Address - Fax:928-771-0920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28766174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ151770Medicaid
AZ151770Medicaid