1265455588 NPI number — WOMANS HEALTHCARE ASSOCIATES PC

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 1265455588 NPI number — WOMANS HEALTHCARE ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOMANS HEALTHCARE ASSOCIATES PC
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:
LAFAYETTE OBSTETRICS AND GYNECOLOGY
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:
1265455588
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7010
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47903-7010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-428-5800
Provider Business Mailing Address Fax Number:
765-428-5802

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3920 ST FRANCIS WAY
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47905-4917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-428-5800
Provider Business Practice Location Address Fax Number:
765-428-5802
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
IDESON
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
765-428-5888

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: 100233180A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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