=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255400636
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOMEN'S HEALTHCARE ASSOCIATES, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2006
-----------------------------------------------------
Last Update Date | 12/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2327 CORONADO ST
-----------------------------------------------------
City | IDAHO FALLS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83404-7407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-557-2900
-----------------------------------------------------
Fax | 208-557-2910
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2327 CORONADO ST
-----------------------------------------------------
City | IDAHO FALLS
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83404-7407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-557-2900
-----------------------------------------------------
Fax | 208-557-2910
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | JEFFREY B BAKER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 208-557-2900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------