1790447977 NPI number — ALL WOMEN'S HEALTH CENTER OF JACKSONVILLE, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790447977 NPI number — ALL WOMEN'S HEALTH CENTER OF JACKSONVILLE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALL WOMEN'S HEALTH CENTER OF JACKSONVILLE, 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:
1790447977
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2021
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:
1545 HUFFINGHAM ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32216-2721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-731-2755
Provider Business Practice Location Address Fax Number:
904-730-7376
Provider Enumeration Date:
10/06/2021

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 REPRESENTATIVE
Authorized Official Telephone Number:
727-442-0445

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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