Healthcare Provider Details

I. General information

NPI: 1285784587
Provider Name (Legal Business Name): ASSOCIATES IN WOMEN'S HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 09/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 HARROUN RD SUITE 201
SYLVANIA OH
43560-2182
US

IV. Provider business mailing address

5300 HARROUN RD SUITE 201
SYLVANIA OH
43560-2182
US

V. Phone/Fax

Practice location:
  • Phone: 419-843-4836
  • Fax: 419-841-8458
Mailing address:
  • Phone: 419-843-4836
  • Fax: 419-841-8458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number34005219
License Number StateOH

VIII. Authorized Official

Name: DR. DAVID W JACKSON
Title or Position: PARTNER
Credential: D.O.
Phone: 419-843-4836