Provider Demographics
NPI:1134158249
Name:WOMENS MEDICAL CENTER, PC
Entity type:Organization
Organization Name:WOMENS MEDICAL CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:PODOLSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-773-3411
Mailing Address - Street 1:1201 SOUTH DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-3256
Mailing Address - Country:US
Mailing Address - Phone:989-773-3411
Mailing Address - Fax:989-775-3187
Practice Address - Street 1:1201 SOUTH DR
Practice Address - Street 2:SUITE 220
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-3256
Practice Address - Country:US
Practice Address - Phone:989-773-3411
Practice Address - Fax:989-775-3187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI160C71016OtherBCBS GROUP #
MI0N40240Medicare ID - Type Unspecified