Provider Demographics
NPI:1376890426
Name:ADVANCED WOMENS HEALTHCARE SC
Entity Type:Organization
Organization Name:ADVANCED WOMENS HEALTHCARE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BAMIDELE
Authorized Official - Middle Name:A
Authorized Official - Last Name:OGUNLEYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-533-2634
Mailing Address - Street 1:2111 E OAKLAND AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-5758
Mailing Address - Country:US
Mailing Address - Phone:309-531-3012
Mailing Address - Fax:
Practice Address - Street 1:2111 E OAKLAND AVE
Practice Address - Street 2:SUITE B
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-5758
Practice Address - Country:US
Practice Address - Phone:309-808-3068
Practice Address - Fax:309-808-3072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty