Provider Demographics
NPI:1548575012
Name:WOMEN OF EXCELLENCE HEALTHCARE, PLLC
Entity type:Organization
Organization Name:WOMEN OF EXCELLENCE HEALTHCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIDALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER-POKU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-987-5500
Mailing Address - Street 1:270 E HUNT HWY
Mailing Address - Street 2:STE 10
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-4962
Mailing Address - Country:US
Mailing Address - Phone:480-987-5500
Mailing Address - Fax:480-987-5507
Practice Address - Street 1:270 E HUNT HWY
Practice Address - Street 2:STE 10
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-4962
Practice Address - Country:US
Practice Address - Phone:480-987-5500
Practice Address - Fax:480-987-5507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ941494Medicaid