=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205906658
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIDLANDS WOMEN'S CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2006
-----------------------------------------------------
Last Update Date | 06/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3020 SUNSET BLVD STE 105
-----------------------------------------------------
City | WEST COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29169-3494
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-798-7660
-----------------------------------------------------
Fax | 803-216-0388
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3020 SUNSET BLVD STE 105
-----------------------------------------------------
City | WEST COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29169-3494
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-798-7660
-----------------------------------------------------
Fax | 803-216-0388
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | PHILIP A LEVIN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 803-798-7660
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------