1609936905 NPI number — WOMEN'S HEALTH SPECIALIST LLC

Table of content: (NPI 1609936905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609936905 NPI number — WOMEN'S HEALTH SPECIALIST LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOMEN'S HEALTH SPECIALIST 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:
1609936905
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
457 SPRUCE ST
Provider Second Line Business Mailing Address:
PO BOX 1067
Provider Business Mailing Address City Name:
WALTERBORO
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29488-2766
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-549-6900
Provider Business Mailing Address Fax Number:
843-549-8051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
457 SPRUCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALTERBORO
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29488-2766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-549-6900
Provider Business Practice Location Address Fax Number:
843-549-8051
Provider Enumeration Date:
12/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RODEFFER-EVANS
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
843-549-6900

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  29448 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GP3378 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com