Provider Demographics
NPI:1205156296
Name:A WOMAN'S PLACE, INC.
Entity type:Organization
Organization Name:A WOMAN'S PLACE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP/OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:352-493-9393
Mailing Address - Street 1:PO BOX 58
Mailing Address - Street 2:
Mailing Address - City:CHIEFLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32644-0058
Mailing Address - Country:US
Mailing Address - Phone:352-493-9393
Mailing Address - Fax:352-493-9390
Practice Address - Street 1:1415 NW 23RD AVE
Practice Address - Street 2:
Practice Address - City:CHIEFLAND
Practice Address - State:FL
Practice Address - Zip Code:32626-1976
Practice Address - Country:US
Practice Address - Phone:352-493-9393
Practice Address - Fax:352-493-9390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-02
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9169564261QR1300X, 261QF0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308581300Medicaid