1508399619 NPI number — DOCTOR OF WOMEN'S HEALTH LLC

Table of content: (NPI 1508399619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508399619 NPI number — DOCTOR OF WOMEN'S HEALTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOCTOR OF WOMEN'S HEALTH LLC
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:
1508399619
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
65 E NASA BLVD STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MELBOURNE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32901-1961
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-802-5655
Provider Business Mailing Address Fax Number:
321-802-5656

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
65 E NASA BLVD STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32901-1961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-802-5655
Provider Business Practice Location Address Fax Number:
321-802-5656
Provider Enumeration Date:
04/05/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCDOWELL
Authorized Official First Name:
ANTONIA
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
321-412-6893

Provider Taxonomy Codes

  • Taxonomy code: 224Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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