Provider Demographics
NPI:1518977982
Name:WOMENS HEALTH ASSOCIATES PA
Entity Type:Organization
Organization Name:WOMENS HEALTH ASSOCIATES PA
Other - Org Name:DR POORTI K RILEY
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:POORTI
Authorized Official - Middle Name:K
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-369-5999
Mailing Address - Street 1:4600 SW 46TH CT.
Mailing Address - Street 2:SUITE 150
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474
Mailing Address - Country:US
Mailing Address - Phone:352-369-5999
Mailing Address - Fax:352-629-4227
Practice Address - Street 1:4600 SW 46TH CT
Practice Address - Street 2:SUITE 150
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-5708
Practice Address - Country:US
Practice Address - Phone:352-369-5999
Practice Address - Fax:352-629-4227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72735207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255755000Medicaid
FLE1920Medicare ID - Type Unspecified
FL255755000Medicaid