Provider Demographics
NPI:1174569974
Name:CRYSTAL RIVER WOMENS HEALTH CENTER PA
Entity type:Organization
Organization Name:CRYSTAL RIVER WOMENS HEALTH CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:SOBEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-794-0878
Mailing Address - Street 1:6151 N SUNCOAST BLVD
Mailing Address - Street 2:STE 1C
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34428
Mailing Address - Country:US
Mailing Address - Phone:352-794-0878
Mailing Address - Fax:352-794-0877
Practice Address - Street 1:6151 N SUNCOAST BLVD
Practice Address - Street 2:STE 1C
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34428
Practice Address - Country:US
Practice Address - Phone:352-794-0878
Practice Address - Fax:352-794-0877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81874174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5629Medicare PIN