Provider Demographics
NPI:1942567326
Name:WOMENS HEALTH CENTER TN
Entity Type:Organization
Organization Name:WOMENS HEALTH CENTER TN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MATSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:423-626-2410
Mailing Address - Street 1:1442 N BROAD ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37879-4361
Mailing Address - Country:US
Mailing Address - Phone:423-626-2410
Mailing Address - Fax:423-626-2591
Practice Address - Street 1:1442 N BROAD ST
Practice Address - Street 2:SUITE 5
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879-4361
Practice Address - Country:US
Practice Address - Phone:423-626-2410
Practice Address - Fax:423-626-2591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-23
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO1498207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103G709179OtherMEDICARE, PTAN
KY64131386Medicaid
TN1528548Medicaid