Provider Demographics
NPI:1437507001
Name:INNOVATIVE WOMENS HEALTH LLC
Entity Type:Organization
Organization Name:INNOVATIVE WOMENS HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNM
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:WAYT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-875-0444
Mailing Address - Street 1:L-3759
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43260-3759
Mailing Address - Country:US
Mailing Address - Phone:614-875-0444
Mailing Address - Fax:614-777-5581
Practice Address - Street 1:3712 RIDGE MILL DR
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026
Practice Address - Country:US
Practice Address - Phone:614-875-0444
Practice Address - Fax:614-777-5581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-24
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058955207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0176402Medicaid