Provider Demographics
NPI:1700929585
Name:WOMEN'S HEALTHCARE OFFICE OF OBGYN
Entity Type:Organization
Organization Name:WOMEN'S HEALTHCARE OFFICE OF OBGYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-345-4640
Mailing Address - Street 1:PO BOX 40978
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38174-0978
Mailing Address - Country:US
Mailing Address - Phone:901-345-4640
Mailing Address - Fax:901-399-7973
Practice Address - Street 1:1264 WESLEY DR
Practice Address - Street 2:SUITE 103
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6400
Practice Address - Country:US
Practice Address - Phone:901-345-4640
Practice Address - Fax:901-399-7973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD020350174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3812313Medicaid
TN4041571OtherBLUE CROSS BLUE SHIELD
TN4041571OtherBLUE CROSS BLUE SHIELD
TN3812313Medicaid