Basic Information
| Provider Information | |||||||||
| NPI: | 1558312090 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOMENS CENTER FOR HEALTH L P | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27555 DIEHL RD | ||||||||
| Address2: | |||||||||
| City: | WARRENVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605553849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6306463884 | ||||||||
| FaxNumber: | 6306463797 | ||||||||
| Practice Location | |||||||||
| Address1: | 76 WEST COUNTRYSIDE PARKWAY | ||||||||
| Address2: | |||||||||
| City: | YORKVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304163300 | ||||||||
| FaxNumber: | 6306465648 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 12/14/2007 | ||||||||
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| AuthorizedOfficialLastName: | OLSON | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6304163300 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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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 | 2221220 | 01 | IL | BCBS | OTHER |