1740619600 NPI number — COMMONWEALTH WOMEN'S CARE, LLC

Table of content: (NPI 1740619600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740619600 NPI number — COMMONWEALTH WOMEN'S CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMONWEALTH WOMEN'S CARE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740619600
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
135 COMMONWEALTH DRIVE
Provider Second Line Business Mailing Address:
SUITE 230
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-365-0250
Provider Business Mailing Address Fax Number:
864-365-0251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
135 COMMONWEALTH DR
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29615-4831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-365-0250
Provider Business Practice Location Address Fax Number:
864-365-0251
Provider Enumeration Date:
11/01/2013

Additional Information

Authorized Official

Authorized Official Last Name:
STONER
Authorized Official First Name:
CHYREL
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
864-365-0250

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MD14087 . This is a "LICENSE FOR DR. DAVID GODWIN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: MD11149 . This is a "LICENSE DR. EVERETT FULLER" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: MD11149 . This is a "LICENSE DR. CHYREL STONER" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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