Provider Demographics
NPI:1326009341
Name:PINES HEALTHCARE FOR WOMEN
Entity Type:Organization
Organization Name:PINES HEALTHCARE FOR WOMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOHLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-557-9663
Mailing Address - Street 1:2100 ASBURY RD
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-3091
Mailing Address - Country:US
Mailing Address - Phone:563-557-9663
Mailing Address - Fax:563-587-0496
Practice Address - Street 1:2100 ASBURY RD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-3091
Practice Address - Country:US
Practice Address - Phone:563-557-9663
Practice Address - Fax:563-587-0496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
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
IA0284729Medicaid
I7784Medicare ID - Type Unspecified