Basic Information
| Provider Information | |||||||||
| NPI: | 1861405037 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVOCATES FOR WOMEN'S HEALTH, PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4801 OLYMPIA PARK PLAZA | ||||||||
| Address2: | STE 2200 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024239595 | ||||||||
| FaxNumber: | 5024239970 | ||||||||
| Practice Location | |||||||||
| Address1: | 4801 OLYMPIA PARK PLAZA | ||||||||
| Address2: | STE 2200 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5024239595 | ||||||||
| FaxNumber: | 5024239970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 10/04/2010 | ||||||||
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| AuthorizedOfficialLastName: | WALSH | ||||||||
| AuthorizedOfficialFirstName: | LEIGH | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/MD | ||||||||
| AuthorizedOfficialTelephone: | 5024239595 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 00-462042-3 | KY | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 65925109 | 05 | KY | MEDICAID |