Provider Demographics
NPI:1396798146
Name:WOMANS CLINIC PA
Entity type:Organization
Organization Name:WOMANS CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED MEDICAL CODER
Authorized Official - Prefix:
Authorized Official - First Name:TAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-699-5042
Mailing Address - Street 1:475 HEYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1726
Mailing Address - Country:US
Mailing Address - Phone:864-699-5020
Mailing Address - Fax:864-699-5050
Practice Address - Street 1:475 HEYWOOD AVE
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1726
Practice Address - Country:US
Practice Address - Phone:864-699-5020
Practice Address - Fax:864-699-5050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA0800Medicaid
SC7448Medicare PIN