Provider Demographics
NPI:1841289915
Name:WOMEN'S HEALTH CENTER, PROFESSIONAL ASSOCIATION
Entity type:Organization
Organization Name:WOMEN'S HEALTH CENTER, PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUZETTE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-322-8500
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-0309
Mailing Address - Country:US
Mailing Address - Phone:316-322-8500
Mailing Address - Fax:316-322-7750
Practice Address - Street 1:700 W CENTRAL AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-2184
Practice Address - Country:US
Practice Address - Phone:316-322-8500
Practice Address - Fax:316-322-7750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS28212207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSG89783Medicare UPIN
KS055693Medicare ID - Type Unspecified