Provider Demographics
NPI:1831246487
Name:NORTHEASTERN WISCONSIN WOMENS HEALTH CARE ASSOCIATES SC
Entity type:Organization
Organization Name:NORTHEASTERN WISCONSIN WOMENS HEALTH CARE ASSOCIATES SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:920-846-9995
Mailing Address - Street 1:835 S MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:OCONTO FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54154-1282
Mailing Address - Country:US
Mailing Address - Phone:920-846-9995
Mailing Address - Fax:920-846-8031
Practice Address - Street 1:835 S MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:OCONTO FALLS
Practice Address - State:WI
Practice Address - Zip Code:54154-1282
Practice Address - Country:US
Practice Address - Phone:920-846-9995
Practice Address - Fax:920-846-8031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50013207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1750384913OtherNPI PATERSON
WI1518941418OtherNPI BOWERS
WI=========012OtherANTHEM BXBS