Provider Demographics
NPI:1134237993
Name:ADVANCED WOMEN'S HEALTHCARE, A MEDICAL CORPORATION
Entity type:Organization
Organization Name:ADVANCED WOMEN'S HEALTHCARE, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JOLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGON
Authorized Official - Suffix:
Authorized Official - Credentials:NP, CNM
Authorized Official - Phone:760-327-7900
Mailing Address - Street 1:1180 N INDIAN CANYON DR STE W300
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4809
Mailing Address - Country:US
Mailing Address - Phone:760-327-7900
Mailing Address - Fax:760-327-7905
Practice Address - Street 1:1180 N INDIAN CANYON DR STE W300
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4809
Practice Address - Country:US
Practice Address - Phone:760-327-7900
Practice Address - Fax:760-327-7905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86905207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0101241Medicaid
CAGR0101242Medicaid
CAGR0101240Medicaid
CAZZZ27958ZMedicare ID - Type UnspecifiedMEDICARE GROUP ID
CAI09349Medicare UPIN