1295982767 NPI number — WOMEN'S OBSTETRICAL & GYNECOLOGICAL CENTER OF COUNTRYSIDE, INC

Table of content: (NPI 1295982767)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295982767 NPI number — WOMEN'S OBSTETRICAL & GYNECOLOGICAL CENTER OF COUNTRYSIDE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOMEN'S OBSTETRICAL & GYNECOLOGICAL CENTER OF COUNTRYSIDE, 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:
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:
1295982767
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2106 DREW STREET
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33765-3238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-442-0445
Provider Business Mailing Address Fax Number:
727-447-3797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28960 US HWY 19 NORTH
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
CLEARWATER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33761-2403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-785-2525
Provider Business Practice Location Address Fax Number:
727-785-7712
Provider Enumeration Date:
08/26/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RAMBO
Authorized Official First Name:
VICKI
Authorized Official Middle Name:
Authorized Official Title or Position:
INSURANCE BILLING & CREDENTIALING R
Authorized Official Telephone Number:
727-442-0445

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  753 , 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)





Copyright © 2007-2025 www.npivalidator.com