1508987629 NPI number — PHYSICIANS & SURGEONS FOR WOMEN, INC

Table of content: (NPI 1508987629)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508987629 NPI number — PHYSICIANS & SURGEONS FOR WOMEN, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIANS & SURGEONS FOR WOMEN, 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:
DAVID BILLING MD. LISA DELONG M.D RICHARD MCNEELY D.O. ANGELA JACKSON
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:
1508987629
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1821 E HIGH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45505-1225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-323-7340
Provider Business Mailing Address Fax Number:
937-323-3363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1821 E HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45505-1225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-323-7340
Provider Business Practice Location Address Fax Number:
937-323-3363
Provider Enumeration Date:
04/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BILLING
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
937-323-7340

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  35100047 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207V00000X , with the licence number: 34004683 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 35064397 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 35084279 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0782238 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1700883147 . This is a "NPI FOR DAVID R. BILLING" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0166716 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0314761 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1255338604 . This is a "NPI FOR LISA M. DELONG" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1841297835 . This is a "NPI ANGELA R JACKSON MD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2525486 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1568469914 . This is a "NPI FOR RICHARD G. MCNEEL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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