Provider Demographics
NPI:1083940084
Name:LAUREL CENTER FOR WOMEN, LLC
Entity Type:Organization
Organization Name:LAUREL CENTER FOR WOMEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROESCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-277-5645
Mailing Address - Street 1:10 ENTERPRISE BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3554
Mailing Address - Country:US
Mailing Address - Phone:864-277-5645
Mailing Address - Fax:864-277-9427
Practice Address - Street 1:10 ENTERPRISE BLVD STE 210
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3554
Practice Address - Country:US
Practice Address - Phone:864-277-5645
Practice Address - Fax:864-277-9427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14872207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty