1356370100 NPI number — WOMENS CENTER A MEDICAL CORPORATION

Table of content: (NPI 1356370100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356370100 NPI number — WOMENS CENTER A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOMENS CENTER A MEDICAL CORPORATION
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:
1356370100
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 MEADOWCREST ST
Provider Second Line Business Mailing Address:
SUITE 350
Provider Business Mailing Address City Name:
GRETNA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70056-5255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-391-7678
Provider Business Mailing Address Fax Number:
504-656-8725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
61 MAGNOLIA TRACE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARVEY
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70058-6112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-656-0319
Provider Business Practice Location Address Fax Number:
504-656-8725
Provider Enumeration Date:
07/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VOROS
Authorized Official First Name:
JANOS
Authorized Official Middle Name:
I
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
504-391-7678

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  010032 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 265601375C . This is a "BC OF LA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1128317 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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