Provider Demographics
NPI:1265209720
Name:CHICAGO WOMEN'S HEALTH, ORGANIZATION, LLC
Entity type:Organization
Organization Name:CHICAGO WOMEN'S HEALTH, ORGANIZATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:L
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-594-7043
Mailing Address - Street 1:2918 HILLRISE DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4702
Mailing Address - Country:US
Mailing Address - Phone:601-594-7043
Mailing Address - Fax:
Practice Address - Street 1:3140 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3410
Practice Address - Country:US
Practice Address - Phone:773-961-7425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VC0300XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyComplex Family PlanningGroup - Single Specialty