1295915056 NPI number — UNION COUNTY WOMEN'S CARE, PA

Table of content: (NPI 1295915056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295915056 NPI number — UNION COUNTY WOMEN'S CARE, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNION COUNTY WOMEN'S CARE, 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:
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:
1295915056
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1424 E FRANKLIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28112-5160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-289-8129
Provider Business Mailing Address Fax Number:
704-289-5967

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1424 E FRANKLIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28112-5160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-289-8129
Provider Business Practice Location Address Fax Number:
704-289-5967
Provider Enumeration Date:
11/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FRANCIS-LANE
Authorized Official First Name:
MILLICENT
Authorized Official Middle Name:
AUGUSTA
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
704-289-8129

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: 8933643 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: N31816 . This is a "MEDICAID SOUTH CAROLINA" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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