Provider Demographics
NPI:1215122767
Name:ADOLESCENT AND ADULT WOMEN'S CARE, PA
Entity type:Organization
Organization Name:ADOLESCENT AND ADULT WOMEN'S CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SAKATOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-485-2270
Mailing Address - Street 1:1052 13TH ST SE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4164
Mailing Address - Country:US
Mailing Address - Phone:828-485-2270
Mailing Address - Fax:828-485-2268
Practice Address - Street 1:1052 13TH ST SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4164
Practice Address - Country:US
Practice Address - Phone:828-485-2270
Practice Address - Fax:828-485-2268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC639295OtherWELLPATH
SC1912974965Medicaid
SC1912974965Medicaid