Provider Demographics
NPI:1386847887
Name:CARITAS WOMANCARE INC
Entity Type:Organization
Organization Name:CARITAS WOMANCARE INC
Other - Org Name:CARITAS WOMANCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MSO CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:LAROCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-449-4168
Mailing Address - Street 1:150 N SYKES CREEK PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-3488
Mailing Address - Country:US
Mailing Address - Phone:321-449-4168
Mailing Address - Fax:321-449-4164
Practice Address - Street 1:240 N WICKHAM RD
Practice Address - Street 2:STE 104
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8662
Practice Address - Country:US
Practice Address - Phone:321-242-1325
Practice Address - Fax:321-242-1870
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WUESTHOFF FAMILY PHYSICIANS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-11
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0075697207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCJ547AMedicare PIN