Basic Information
| Provider Information | |||||||||
| NPI: | 1518977982 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOMENS HEALTH ASSOCIATES PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DR POORTI K RILEY | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4600 SW 46TH CT. | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523695999 | ||||||||
| FaxNumber: | 3526294227 | ||||||||
| Practice Location | |||||||||
| Address1: | 4600 SW 46TH CT | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344745708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523695999 | ||||||||
| FaxNumber: | 3526294227 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 01/13/2011 | ||||||||
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| AuthorizedOfficialLastName: | RILEY | ||||||||
| AuthorizedOfficialFirstName: | POORTI | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 3523695999 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | ME72735 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 255755000 | 05 | FL | MEDICAID |