Provider Demographics
NPI:1609936905
Name:WOMEN'S HEALTH SPECIALIST LLC
Entity Type:Organization
Organization Name:WOMEN'S HEALTH SPECIALIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RODEFFER-EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-549-6900
Mailing Address - Street 1:457 SPRUCE ST
Mailing Address - Street 2:PO BOX 1067
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-2766
Mailing Address - Country:US
Mailing Address - Phone:843-549-6900
Mailing Address - Fax:843-549-8051
Practice Address - Street 1:457 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-2766
Practice Address - Country:US
Practice Address - Phone:843-549-6900
Practice Address - Fax:843-549-8051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29448207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3378Medicaid
SCF93447Medicare UPIN