Provider Demographics
NPI:1063481471
Name:ASCENSION CENTER FOR WOMENS HEALTH, LLC
Entity Type:Organization
Organization Name:ASCENSION CENTER FOR WOMENS HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:D
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-743-2424
Mailing Address - Street 1:1212 RIVERVIEW BLVD
Mailing Address - Street 2:SUITE 3015
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-5023
Mailing Address - Country:US
Mailing Address - Phone:225-743-2424
Mailing Address - Fax:225-743-2428
Practice Address - Street 1:1212 RIVERVIEW BLVD
Practice Address - Street 2:SUITE 3015
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-5023
Practice Address - Country:US
Practice Address - Phone:225-743-2424
Practice Address - Fax:225-743-2428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA02528207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1621820Medicaid
LA5CQ47Medicare ID - Type Unspecified