Provider Demographics
NPI:1538144688
Name:TARBORO WOMEN'S CENTER PA
Entity Type:Organization
Organization Name:TARBORO WOMEN'S CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-823-6333
Mailing Address - Street 1:PO BOX 1257
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-1257
Mailing Address - Country:US
Mailing Address - Phone:252-823-6333
Mailing Address - Fax:252-823-1406
Practice Address - Street 1:2704 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-1918
Practice Address - Country:US
Practice Address - Phone:252-823-6333
Practice Address - Fax:252-823-1406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0241EOtherBLUE CROSS BLUE SHIELD
NC890241EMedicaid
NCCK3101OtherRAILROAD MEDICARE
NC890241EMedicaid