=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124257209
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOMENS HEALTHCARE CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2009
-----------------------------------------------------
Last Update Date | 07/09/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 MEDICAL PARK DR SUITE 1
-----------------------------------------------------
City | ANDALUSIA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36420-5354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-222-1583
-----------------------------------------------------
Fax | 334-222-1573
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 215 MEDICAL PARK DR SUITE 1
-----------------------------------------------------
City | ANDALUSIA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36420-5354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-222-1583
-----------------------------------------------------
Fax | 334-222-1573
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NP/PRESIDENT
-----------------------------------------------------
Name | MS. STELLA L. VINSON
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 334-222-1583
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 1061816
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | DO833
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------