Provider Demographics
NPI:1699904920
Name:OCALA WOMENS CENTER LLC
Entity type:Organization
Organization Name:OCALA WOMENS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:PENDERGRAFT
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:352-401-9288
Mailing Address - Street 1:108 NW PINE AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34475-6619
Mailing Address - Country:US
Mailing Address - Phone:352-540-1928
Mailing Address - Fax:352-401-7657
Practice Address - Street 1:108 NW PINE AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34475-6619
Practice Address - Country:US
Practice Address - Phone:352-540-1928
Practice Address - Fax:352-401-7657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty