Provider Demographics
NPI:1720057680
Name:WOMEN PHYSICIANS ASSOCIATES OBGYN PA
Entity Type:Organization
Organization Name:WOMEN PHYSICIANS ASSOCIATES OBGYN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LILLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-779-6776
Mailing Address - Street 1:9 MEDICAL PARK RD
Mailing Address - Street 2:STE 620
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6873
Mailing Address - Country:US
Mailing Address - Phone:803-779-6776
Mailing Address - Fax:803-779-7346
Practice Address - Street 1:9 MEDICAL PARK RD
Practice Address - Street 2:STE 620
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6873
Practice Address - Country:US
Practice Address - Phone:803-779-6776
Practice Address - Fax:803-779-7346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9293207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4291Medicare ID - Type Unspecified