Provider Demographics
NPI:1194028787
Name:ATHENA WOMENS CARE LLC
Entity Type:Organization
Organization Name:ATHENA WOMENS CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GEMMELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-532-2322
Mailing Address - Street 1:911 LIGONIER ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-1805
Mailing Address - Country:US
Mailing Address - Phone:724-532-2322
Mailing Address - Fax:724-532-2405
Practice Address - Street 1:911 LIGONIER ST
Practice Address - Street 2:SUITE 205
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1805
Practice Address - Country:US
Practice Address - Phone:724-532-2322
Practice Address - Fax:724-532-2405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty