Basic Information
| Provider Information | |||||||||
| NPI: | 1659526481 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOMENS HEALTH FIRST PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1108 W STATE ST | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | HASTINGS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490589711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2699458080 | ||||||||
| FaxNumber: | 2699458081 | ||||||||
| Practice Location | |||||||||
| Address1: | 1108 W STATE ST | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | HASTINGS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490589711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2699458080 | ||||||||
| FaxNumber: | 2699458081 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2008 | ||||||||
| LastUpdateDate: | 12/03/2009 | ||||||||
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| AuthorizedOfficialLastName: | DOHERTY | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2699458080 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | LD068172 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 4210140 | 05 | MI | MEDICAID |