1235678756 NPI number — PREMIER WOMEN'S CARE OB/GYN PLLC

Table of content: (NPI 1235678756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235678756 NPI number — PREMIER WOMEN'S CARE OB/GYN PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER WOMEN'S CARE OB/GYN PLLC
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:
1235678756
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2250 OSPREY BLVD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
BARTOW
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33830-4340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-488-2702
Provider Business Mailing Address Fax Number:
888-235-9876

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2250 OSPREY BLVD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
BARTOW
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33830-4340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-488-2702
Provider Business Practice Location Address Fax Number:
888-235-9876
Provider Enumeration Date:
02/16/2017

Additional Information

Authorized Official

Authorized Official Last Name:
RAMCHANDANI
Authorized Official First Name:
SANJAY
Authorized Official Middle Name:
MOHAN
Authorized Official Title or Position:
MANAGING DIRECTOR
Authorized Official Telephone Number:
888-488-2702

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  ME125157 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8023183 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: H65501 . This is a "UPIN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 020416000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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