1093761686 NPI number — REGIONAL WOMENS HEALTH GROUP LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093761686 NPI number — REGIONAL WOMENS HEALTH GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REGIONAL WOMENS HEALTH GROUP 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:
RWHG VIRTUA CENTER FOR WOMEN
Provider Other Organization Name Type Code:
3
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:
1093761686
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/05/2007
NPI Reactivation Date:
03/02/2007

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 71421
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19176-1421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-669-6050
Provider Business Mailing Address Fax Number:
856-651-0794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 BOWMAN DR STE E340
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VOORHEES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08043-9636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-247-7600
Provider Business Practice Location Address Fax Number:
856-247-7575
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DONOVAN
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
C
Authorized Official Title or Position:
VP, REV CYCLE
Authorized Official Telephone Number:
856-669-6050

Provider Taxonomy Codes

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

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

  • Identifier: 8328706 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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