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General NPI Number Information
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NPI Number | 1083989578
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Entity Type | Organization
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Legal Business Name | ILLINOIS WOMEN'S HEALTH CENTER
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Dates
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Enumeration Date | 03/15/2012
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Last Update Date | 03/15/2012
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Provider Practice Location Address
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Address Line | 5401 N KNOXVILLE AVE SUITE 114
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City | PEORIA
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State | IL
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Zip | 61614-5098
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Country | US
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Telephone | 309-683-0200
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Fax | 309-683-0201
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Provider Business Mailing Address
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Address Line | 5401 N KNOXVILLE AVE SUITE 114
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City | PEORIA
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State | IL
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Zip | 61614-5098
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Country | US
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Telephone | 309-683-0200
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Fax | 309-683-0201
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Authorized Official
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Title or Position | OWNER/SUPERVISING PHYSICIAN
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Name | DR. LINDSEY A MA
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Credential | M.D.
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Telephone | 309-683-0200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 036083144
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 209001128
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License Number State | IL
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