=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881877512
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOMENS CARE ASSOCIATES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2007
-----------------------------------------------------
Last Update Date | 04/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 830 CENTURY MEDICAL DR SUITE B
-----------------------------------------------------
City | TITUSVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32796-2149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-383-3203
-----------------------------------------------------
Fax | 321-383-3060
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 830 CENTURY MEDICAL DR SUITE B
-----------------------------------------------------
City | TITUSVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32796-2149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-383-3203
-----------------------------------------------------
Fax | 321-383-3060
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | DR. HAE SOO LIM
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 321-269-6056
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 76129
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------