1174569974 NPI number — CRYSTAL RIVER WOMENS HEALTH CENTER PA

Table of content: (NPI 1174569974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174569974 NPI number — CRYSTAL RIVER WOMENS HEALTH CENTER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRYSTAL RIVER WOMENS HEALTH CENTER PA
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:
1174569974
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6151 N SUNCOAST BLVD
Provider Second Line Business Mailing Address:
STE 1C
Provider Business Mailing Address City Name:
CRYSTAL RIVER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-794-0878
Provider Business Mailing Address Fax Number:
352-794-0877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6151 N SUNCOAST BLVD
Provider Second Line Business Practice Location Address:
STE 1C
Provider Business Practice Location Address City Name:
CRYSTAL RIVER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-794-0878
Provider Business Practice Location Address Fax Number:
352-794-0877
Provider Enumeration Date:
06/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SOBEL
Authorized Official First Name:
ROSE
Authorized Official Middle Name:
MARY
Authorized Official Title or Position:
DR OWNER
Authorized Official Telephone Number:
352-794-0878

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME81874 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: ME81874 , 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)





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