Provider Demographics
NPI:1336172097
Name:WOMEN'S HEALTH CENTER, INC. PS
Entity Type:Organization
Organization Name:WOMEN'S HEALTH CENTER, INC. PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KLEBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-248-0854
Mailing Address - Street 1:702 SW COLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:NORMANDY PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3938
Mailing Address - Country:US
Mailing Address - Phone:206-248-0854
Mailing Address - Fax:
Practice Address - Street 1:702 SW COLEWOOD LN
Practice Address - Street 2:
Practice Address - City:NORMANDY PARK
Practice Address - State:WA
Practice Address - Zip Code:98166-3938
Practice Address - Country:US
Practice Address - Phone:206-248-0854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7055213Medicaid