Provider Demographics
NPI:1235123092
Name:FOSTER WOMEN'S CARE
Entity Type:Organization
Organization Name:FOSTER WOMEN'S CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPERRAZZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-952-9500
Mailing Address - Street 1:1318 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3117
Mailing Address - Country:US
Mailing Address - Phone:321-952-9500
Mailing Address - Fax:321-952-2299
Practice Address - Street 1:1318 S PINE ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3117
Practice Address - Country:US
Practice Address - Phone:321-952-9500
Practice Address - Fax:321-952-2299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78114207V00000X
FLOS6956207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34203Medicare PIN