Provider Demographics
NPI:1992047120
Name:LIFESPRINGS WOMENS HEALTHCARE, LLC
Entity type:Organization
Organization Name:LIFESPRINGS WOMENS HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANDERSON
Authorized Official - Last Name:MADDRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-355-4233
Mailing Address - Street 1:627 MIDDLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-5014
Mailing Address - Country:US
Mailing Address - Phone:865-365-4233
Mailing Address - Fax:865-365-4234
Practice Address - Street 1:627 MIDDLE CREEK RD
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-5014
Practice Address - Country:US
Practice Address - Phone:865-365-4233
Practice Address - Fax:865-365-4234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43185207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN41120BMedicare UPIN