Provider Demographics
NPI:1659328763
Name:VILLAGE GYNECOLOGY MD PA
Entity Type:Organization
Organization Name:VILLAGE GYNECOLOGY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:STEEPY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-259-5740
Mailing Address - Street 1:1503 BUENOS AIRES BLVD
Mailing Address - Street 2:SUITE 181
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-8999
Mailing Address - Country:US
Mailing Address - Phone:352-259-5740
Mailing Address - Fax:352-259-5745
Practice Address - Street 1:1503 BUENOS AIRES BLVD
Practice Address - Street 2:SUITE 181
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-8999
Practice Address - Country:US
Practice Address - Phone:352-259-5740
Practice Address - Fax:352-259-5745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85792207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL74716Medicare ID - Type Unspecified