MEDICARE: A WOMAN'S HEALING CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	37957	CO

General Provider Information

NPI Number	:	1457588568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A WOMAN'S HEALING CENTER, LLC

Provider Business Mailing Address
First Line	:	1006 LUKE ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4016
Country	:	US
Telephone Number	:	970-419-1111
Fax Number	:	970-407-0001

Provider Business Practice Location Address
First Line	:	1006 LUKE ST
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4016
Country	:	US
Telephone Number	:	970-419-1111
Fax Number	:	970-407-0001

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MRS. AMANDA HILGENDORF
Credential	:
Telephone Number	:	970-419-1111

Provider Enumeration Date	:	06/16/2009
Last Update Date	:	06/16/2009

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