Provider Demographics
NPI:1295982767
Name:WOMEN'S OBSTETRICAL & GYNECOLOGICAL CENTER OF COUNTRYSIDE, INC
Entity type:Organization
Organization Name:WOMEN'S OBSTETRICAL & GYNECOLOGICAL CENTER OF COUNTRYSIDE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE BILLING & CREDENTIALING R
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-442-0445
Mailing Address - Street 1:2106 DREW STREET
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3238
Mailing Address - Country:US
Mailing Address - Phone:727-442-0445
Mailing Address - Fax:727-447-3797
Practice Address - Street 1:28960 US HWY 19 NORTH
Practice Address - Street 2:SUITE 110
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2403
Practice Address - Country:US
Practice Address - Phone:727-785-2525
Practice Address - Fax:727-785-7712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL753207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty