1477655264 NPI number — ALL WOMENS CARE P C

Table of content: (NPI 1477655264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477655264 NPI number — ALL WOMENS CARE P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALL WOMENS CARE P C
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:
1477655264
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 NW LOUISIANA AVE
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
BEND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97701-3203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-388-8253
Provider Business Mailing Address Fax Number:
541-617-0894

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 NW LOUISIANA AVE
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
BEND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97701-3203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-388-8253
Provider Business Practice Location Address Fax Number:
541-617-0894
Provider Enumeration Date:
09/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LYNCH MILLER
Authorized Official First Name:
ALISON
Authorized Official Middle Name:
KAY
Authorized Official Title or Position:
PRESIDENTPHYSICIAN
Authorized Official Telephone Number:
541-388-8253

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  17286/20470 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM2500X , with the licence number: 17286/20470 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 150265/066659 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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