Provider Demographics
NPI:1811952047
Name:WOMENS MEDICAL HEALTH CENTER INC
Entity type:Organization
Organization Name:WOMENS MEDICAL HEALTH CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/NP
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:HENSON
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:928-505-5300
Mailing Address - Street 1:1956 MESQUITE AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5888
Mailing Address - Country:US
Mailing Address - Phone:928-505-5300
Mailing Address - Fax:928-505-2333
Practice Address - Street 1:1956 MESQUITE AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5888
Practice Address - Country:US
Practice Address - Phone:928-505-5300
Practice Address - Fax:928-505-2333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZNP54363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0153580OtherBLUE CROSS BLUE SHIELD
AZ333253Medicaid
AZAZ0153580OtherBLUE CROSS BLUE SHIELD
AZ107092Medicare ID - Type UnspecifiedGROUP
AZS46071Medicare UPIN