Basic Information
| Provider Information | |||||||||
| NPI: | 1467579789 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOLIET WOMENS HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 N HAMMES AVE | ||||||||
| Address2: | |||||||||
| City: | JOLIET | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604356611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157252699 | ||||||||
| FaxNumber: | 8157252120 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 N HAMMES AVE | ||||||||
| Address2: | |||||||||
| City: | JOLIET | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604356611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157252699 | ||||||||
| FaxNumber: | 8157252120 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2007 | ||||||||
| LastUpdateDate: | 02/13/2012 | ||||||||
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| AuthorizedOfficialLastName: | MOAURO | ||||||||
| AuthorizedOfficialFirstName: | CASEY | ||||||||
| AuthorizedOfficialMiddleName: | ALLAN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8157252699 | ||||||||
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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 |
No ID Information.