1174630560 NPI number — WOMENS HEALTH ALLIANCE, PA

Table of content: (NPI 1174630560)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174630560 NPI number — WOMENS HEALTH ALLIANCE, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOMENS HEALTH ALLIANCE, PA
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:
6
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:
1174630560
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2615 LAKE DR
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27607-6686
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-781-9555
Provider Business Mailing Address Fax Number:
919-781-1070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2417 ATRIUM DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27607-6673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-781-9555
Provider Business Practice Location Address Fax Number:
919-781-1070
Provider Enumeration Date:
08/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
RUTH
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
919-781-9555

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: 019JR . This is a "BCBS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2343239M . This is a "MEDICARE ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5907798 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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