MEDICARE: WOMENS MEDICAL HEALTH CENTER INC

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	363L00000X	Nurse Practitioner	AZNP54	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0153580	OTHER	AZ	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811952047
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMENS MEDICAL HEALTH CENTER INC

Provider Business Mailing Address
First Line	:	1956 MESQUITE AVE
Second Line	:	SUITE 103
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5888
Country	:	US
Telephone Number	:	928-505-5300
Fax Number	:	928-505-2333

Provider Business Practice Location Address
First Line	:	1956 MESQUITE AVE
Second Line	:	SUITE 103
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5888
Country	:	US
Telephone Number	:	928-505-5300
Fax Number	:	928-505-2333

Authorized Official
Title or Position	:	OWNER/NP
Name	:	ELAINE RUTH HENSON
Credential	:	ANP
Telephone Number	:	928-505-5300

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	08/22/2020

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