Provider Demographics
NPI:1790865087
Name:PARKSIDE WOMENS CENTRE, LLC
Entity Type:Organization
Organization Name:PARKSIDE WOMENS CENTRE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:L B
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-649-7746
Mailing Address - Street 1:PO BOX 5669
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29804-5669
Mailing Address - Country:US
Mailing Address - Phone:803-649-7746
Mailing Address - Fax:803-649-7730
Practice Address - Street 1:1518 TWO NOTCH RD SE
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-5551
Practice Address - Country:US
Practice Address - Phone:803-649-7746
Practice Address - Fax:803-649-7730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3641Medicaid
SC7578Medicare ID - Type UnspecifiedMEDICARE
SCF89894Medicare UPIN