Provider Demographics
NPI:1962659714
Name:THE WOMEN'S HEALTH CENTER OF MAUI, LLC
Entity Type:Organization
Organization Name:THE WOMEN'S HEALTH CENTER OF MAUI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-242-9787
Mailing Address - Street 1:30 N CHURCH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1600
Mailing Address - Country:US
Mailing Address - Phone:808-242-9787
Mailing Address - Fax:808-242-4518
Practice Address - Street 1:30 N CHURCH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1600
Practice Address - Country:US
Practice Address - Phone:808-242-9787
Practice Address - Fax:808-242-4518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-23
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD10631174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIA08256Medicare UPIN