Provider Demographics
NPI:1841386166
Name:EDGERTON WOMEN'S HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:EDGERTON WOMEN'S HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNIKA
Authorized Official - Middle Name:K
Authorized Official - Last Name:O'MELIA
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:563-359-6633
Mailing Address - Street 1:1510 E RUSHOLME ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2463
Mailing Address - Country:US
Mailing Address - Phone:563-359-6633
Mailing Address - Fax:563-359-5261
Practice Address - Street 1:1510 E RUSHOLME ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2463
Practice Address - Country:US
Practice Address - Phone:563-359-6633
Practice Address - Fax:563-359-5261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0164541Medicaid