Basic Information
| Provider Information | |||||||||
| NPI: | 1265511737 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSOCIATES FOR WOMEN'S HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 533 E COUNTY LINE RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461431048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178596626 | ||||||||
| FaxNumber: | 3178874691 | ||||||||
| Practice Location | |||||||||
| Address1: | 533 E COUNTY LINE RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461431048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178596626 | ||||||||
| FaxNumber: | 3178874691 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2006 | ||||||||
| LastUpdateDate: | 09/26/2011 | ||||||||
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| AuthorizedOfficialLastName: | ASDELL | ||||||||
| AuthorizedOfficialFirstName: | TESSA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 3178596626 | ||||||||
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| 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 | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 200413310A | 05 | IN | MEDICAID |