Provider Demographics
NPI:1659494292
Name:TOTAL WOMAN CARE, LLC
Entity Type:Organization
Organization Name:TOTAL WOMAN CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCILVEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-526-3500
Mailing Address - Street 1:942 JOHNSON RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-2212
Mailing Address - Country:US
Mailing Address - Phone:336-526-3500
Mailing Address - Fax:336-526-3508
Practice Address - Street 1:942 JOHNSON RIDGE RD
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2212
Practice Address - Country:US
Practice Address - Phone:336-526-3500
Practice Address - Fax:336-526-3508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300501207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8913340Medicaid
NC8913340Medicaid
NC2015255BMedicare ID - Type Unspecified