Provider Demographics
NPI:1003106915
Name:FLORIDA WOMAN CARE, LLC
Entity Type:Organization
Organization Name:FLORIDA WOMAN CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:KONSKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-300-2410
Mailing Address - Street 1:4205 W ATLANTIC AVE
Mailing Address - Street 2:SUITE C-304
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-3901
Mailing Address - Country:US
Mailing Address - Phone:561-300-2410
Mailing Address - Fax:561-495-5408
Practice Address - Street 1:3251 N MCMULLEN BOOTH RD
Practice Address - Street 2:STE 102
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2022
Practice Address - Country:US
Practice Address - Phone:727-669-6811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001553572Medicaid