=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427110634
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IN VOGUE WOMENS CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2006
-----------------------------------------------------
Last Update Date | 07/06/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4850 E. MAIN ST STE 100
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-471-6700
-----------------------------------------------------
Fax | 614-566-0779
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4850 E. MAIN ST STE 100
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-471-6700
-----------------------------------------------------
Fax | 614-566-0779
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DR.
-----------------------------------------------------
Name | MRS. JULIE R VIETA
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 614-471-6700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 34008514
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------