Provider Demographics
NPI:1316080161
Name:ADVANCED WOMENS HEALTH CENTER INC
Entity type:Organization
Organization Name:ADVANCED WOMENS HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:REES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-666-0544
Mailing Address - Street 1:221 MARINER BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-5692
Mailing Address - Country:US
Mailing Address - Phone:352-666-0544
Mailing Address - Fax:352-666-0842
Practice Address - Street 1:221 MARINER BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5692
Practice Address - Country:US
Practice Address - Phone:352-666-0544
Practice Address - Fax:888-309-7754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0062854207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263969600Medicaid
FL263969600Medicaid
FLK1254Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER