Provider Demographics
NPI:1720490048
Name:WOMEN'S HEALTH CENTER & PRIMARY CARE
Entity Type:Organization
Organization Name:WOMEN'S HEALTH CENTER & PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MATSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:423-626-2410
Mailing Address - Street 1:1610 TAZEWELL RD
Mailing Address - Street 2:STE 202
Mailing Address - City:TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37879-3600
Mailing Address - Country:US
Mailing Address - Phone:423-626-2410
Mailing Address - Fax:
Practice Address - Street 1:1610 TAZEWELL RD
Practice Address - Street 2:STE 202
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879-3600
Practice Address - Country:US
Practice Address - Phone:423-626-2410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO1498207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1521614Medicaid