1073648580 NPI number — WOMEN'S HEALTH CARE CENTER, INC.

Table of content: (NPI 1073648580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073648580 NPI number — WOMEN'S HEALTH CARE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOMEN'S HEALTH CARE CENTER, INC.
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:
1073648580
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
513 PINEY FOREST RD
Provider Second Line Business Mailing Address:
LOWER LEVEL
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24540-3353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-792-1330
Provider Business Mailing Address Fax Number:
434-792-2924

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
513 PINEY FOREST RD
Provider Second Line Business Practice Location Address:
LOWER LEVEL
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24540-3353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-792-1330
Provider Business Practice Location Address Fax Number:
434-792-2924
Provider Enumeration Date:
02/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ELIACIN
Authorized Official First Name:
LOUIS
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
434-792-1330

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  0101041452 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 46151 . This is a "OPTIMA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 890546P . This is a "NORTH CAROLINA MEDICAID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 006233058 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 053798 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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