Provider Demographics
NPI:1457940728
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:VP & CFO
Authorized Official - Prefix:
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 1:79200 CORPORATE CENTER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-7245
Mailing Address - Country:US
Mailing Address - Phone:760-327-7900
Mailing Address - Fax:760-327-7905
Practice Address - Street 1:39000 BOB HOPE DR STE K209
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-7019
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:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty