Provider Demographics
NPI:1215013958
Name:EDGERTON WOMENS HEALTH CENTER
Entity Type:Organization
Organization Name:EDGERTON WOMENS HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:FEDJE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-359-6633
Mailing Address - Street 1:1510 E RUSHOLME ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2463
Mailing Address - Country:US
Mailing Address - Phone:563-359-6633
Mailing Address - Fax:563-324-4183
Practice Address - Street 1:1510 E RUSHOLME ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2463
Practice Address - Country:US
Practice Address - Phone:563-359-6633
Practice Address - Fax:563-324-4183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0051425Medicaid