Provider Demographics
NPI:1053455790
Name:NATIONAL WOMEN'S HEALTH ORGANIZATION OF FORT WAYNE
Entity Type:Organization
Organization Name:NATIONAL WOMEN'S HEALTH ORGANIZATION OF FORT WAYNE
Other - Org Name:FORT WAYNE WOMEN'S HEALTH ORGANIZATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:C
Authorized Official - Last Name:TILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-783-0444
Mailing Address - Street 1:2210 INWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-7117
Mailing Address - Country:US
Mailing Address - Phone:260-471-5005
Mailing Address - Fax:
Practice Address - Street 1:2210 INWOOD DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-7117
Practice Address - Country:US
Practice Address - Phone:260-471-5005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN060111354174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN=========OtherEIN