Basic Information
| Provider Information | |||||||||
| NPI: | 1720057680 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOMEN PHYSICIANS ASSOCIATES OBGYN PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 MEDICAL PARK RD | ||||||||
| Address2: | STE 620 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292036873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037796776 | ||||||||
| FaxNumber: | 8037797346 | ||||||||
| Practice Location | |||||||||
| Address1: | 9 MEDICAL PARK RD | ||||||||
| Address2: | STE 620 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292036873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037796776 | ||||||||
| FaxNumber: | 8037797346 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 06/03/2010 | ||||||||
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| AuthorizedOfficialLastName: | FILLER | ||||||||
| AuthorizedOfficialFirstName: | LILLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8037796776 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 9293 | SC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.