Provider Demographics
NPI:1871536540
Name:ADVANTAGE HEALTHCARE FOR WOMEN PLLC
Entity type:Organization
Organization Name:ADVANTAGE HEALTHCARE FOR WOMEN PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOWER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-525-5405
Mailing Address - Street 1:104 MEADOW POINTE
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-9209
Mailing Address - Country:US
Mailing Address - Phone:304-525-5405
Mailing Address - Fax:304-525-3400
Practice Address - Street 1:104 MEADOW POINTE
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-9209
Practice Address - Country:US
Practice Address - Phone:304-525-5405
Practice Address - Fax:304-525-3400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207V00000X
WV207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVCA0445192Medicare PIN