Healthcare Provider Details

I. General information

NPI: 1902145394
Provider Name (Legal Business Name): PRIMA BELLA WOMEN'S HEALTH, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2013
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 E US HIGHWAY 6
VALPARAISO IN
46383-8947
US

IV. Provider business mailing address

PO BOX 1024
VALPARAISO IN
46384-1024
US

V. Phone/Fax

Practice location:
  • Phone: 219-462-0909
  • Fax:
Mailing address:
  • Phone: 219-462-0909
  • Fax: 219-462-9910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number68000075A
License Number StateIN

VIII. Authorized Official

Name: MARY ANN MEYER JONES
Title or Position: PRESIDENT OF CORPORATION
Credential: M.D.
Phone: 219-462-0909