Provider Demographics
NPI:1205851094
Name:BLOSSOM CARE FOR WOMEN PA
Entity Type:Organization
Organization Name:BLOSSOM CARE FOR WOMEN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:T
Authorized Official - Last Name:HELWIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-286-5400
Mailing Address - Street 1:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29721
Mailing Address - Country:US
Mailing Address - Phone:803-286-5400
Mailing Address - Fax:803-286-5488
Practice Address - Street 1:1025 W MEETING ST
Practice Address - Street 2:SUITE 204
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-2204
Practice Address - Country:US
Practice Address - Phone:803-286-5400
Practice Address - Fax:803-286-5488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL28952207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG30610Medicare UPIN