Basic Information
| Provider Information | |||||||||
| NPI: | 1477655264 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALL WOMENS CARE P C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 NW LOUISIANA AVE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977013203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413888253 | ||||||||
| FaxNumber: | 5416170894 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 NW LOUISIANA AVE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977013203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413888253 | ||||||||
| FaxNumber: | 5416170894 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2006 | ||||||||
| LastUpdateDate: | 11/21/2007 | ||||||||
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| AuthorizedOfficialLastName: | LYNCH MILLER | ||||||||
| AuthorizedOfficialFirstName: | ALISON | ||||||||
| AuthorizedOfficialMiddleName: | KAY | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENTPHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 5413888253 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | 17286/20470 | OR | N | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty | 174400000X | 17286/20470 | OR | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 150265/066659 | 05 | OR | MEDICAID |