Mystick Women'S Health, Inc.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

60673 Issued in MA

Legal business name

MYSTICK WOMEN'S HEALTH, INC.

Practice address

13 Bradlee Rd
Medford, MA 02155-3110

Phone

(781) 395-1110

Fax

(781) 395-8553

NPI assigned

Sep 28, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ellen Marie Guthrie, MD

Title

President

Phone

(781) 395-1110

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325203200000",
    "number": "1255422630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13 BRADLEE RD",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021553110",
            "telephone_number": "781-395-1110",
            "fax_number": "781-395-8553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13 BRADLEE RD",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021553110",
            "telephone_number": "781-395-1110",
            "fax_number": "781-395-8553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYSTICK WOMEN'S HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2011-12-30",
        "status": "A",
        "authorized_official_last_name": "GUTHRIE",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "781-395-1110",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "MA",
            "license": "60673",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9711601",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Medford, MA
• Obstetrics & Gynecology Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.