Basic Information
| Provider Information | |||||||||
| NPI: | 1811184989 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MUNCIE WOMENS CENTER PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2501 W JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | MUNCIE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473034632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652862000 | ||||||||
| FaxNumber: | 7652133029 | ||||||||
| Practice Location | |||||||||
| Address1: | 2501 W JACKSON ST | ||||||||
| Address2: | |||||||||
| City: | MUNCIE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473034632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652862000 | ||||||||
| FaxNumber: | 7652133029 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2007 | ||||||||
| LastUpdateDate: | 09/24/2013 | ||||||||
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| AuthorizedOfficialLastName: | REEVES | ||||||||
| AuthorizedOfficialFirstName: | DENISE | ||||||||
| AuthorizedOfficialMiddleName: | SWANSON | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7652862000 | ||||||||
| 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 | 261QM2500X | 01039273A | IN | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
ID Information
| ID | Type | State | Issuer | Description | 200350480A | 05 | IN | MEDICAID |