Healthcare Provider Details

I. General information

NPI: 1689838120
Provider Name (Legal Business Name): WOMEN'S HEALTHSOURCE, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2008
Last Update Date: 05/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 WOOD ST
MONROE LA
71201-7445
US

IV. Provider business mailing address

410 WOOD ST
MONROE LA
71201-7445
US

V. Phone/Fax

Practice location:
  • Phone: 318-325-1731
  • Fax: 318-325-5636
Mailing address:
  • Phone: 318-325-1731
  • Fax: 318-325-5636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD012257
License Number StateLA

VIII. Authorized Official

Name: TINA SMITH
Title or Position: OWNER
Credential: NP
Phone: 318-325-1731