Provider Demographics
NPI:1205536703
Name:OVUM MEDICAL, LLC
Entity type:Organization
Organization Name:OVUM MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRISCI
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:310-927-1017
Mailing Address - Street 1:929 IRISH RD
Mailing Address - Street 2:
Mailing Address - City:SAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83860-5031
Mailing Address - Country:US
Mailing Address - Phone:208-217-1102
Mailing Address - Fax:
Practice Address - Street 1:929 IRISH RD
Practice Address - Street 2:
Practice Address - City:SAGLE
Practice Address - State:ID
Practice Address - Zip Code:83860-5031
Practice Address - Country:US
Practice Address - Phone:208-217-1102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VC0300XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyComplex Family PlanningGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
No163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-RiskGroup - Multi-Specialty
No170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Multi-Specialty
No170300000XOther Service ProvidersGenetic Counselor, MSGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Multi-Specialty
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty