Basic Information
Provider Information
NPI: 1316925738
EntityType: 2
ReplacementNPI:  
OrganizationName: WOMEN'S MEDICAL CARE, INC.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: P.O. BOX 643047
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452640001
CountryCode: US
TelephoneNumber: 4407776017
FaxNumber: 4407776940
Practice Location
Address1: 30 E APPLE ST
Address2: SUITE 5257
City: DAYTON
State: OH
PostalCode: 454092939
CountryCode: US
TelephoneNumber: 9372085080
FaxNumber: 9372085092
Other Information
ProviderEnumerationDate: 01/05/2006
LastUpdateDate: 06/12/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: KASSEM
AuthorizedOfficialFirstName: WALID
AuthorizedOfficialMiddleName: S.
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 9372085080
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: M.D.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


Home