Provider Demographics
NPI:1336193481
Name:WOMEN'S SPECIALTY CENTER, LLC
Entity Type:Organization
Organization Name:WOMEN'S SPECIALTY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-948-6540
Mailing Address - Street 1:501 MARSHALL STREET
Mailing Address - Street 2:SUITE 600
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-1650
Mailing Address - Country:US
Mailing Address - Phone:601-948-6540
Mailing Address - Fax:601-326-1501
Practice Address - Street 1:501 MARSHALL STREET
Practice Address - Street 2:SUITE 600
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1650
Practice Address - Country:US
Practice Address - Phone:601-948-6540
Practice Address - Fax:601-326-1501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
No207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSCI7513OtherRAILROAD MEDICARE
MS09014928Medicaid
MS09014928Medicaid