MEDICARE: WOMENS CARE FLORDIA LLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295971224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMENS CARE FLORDIA LLP

Provider Business Mailing Address
First Line	:	PO BOX 748817
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-8817
Country	:	US
Telephone Number	:	813-286-0033
Fax Number	:	813-282-1806

Provider Business Practice Location Address
First Line	:	5470 LITHIA PINECREST RD
Second Line	:
City	:	LITHIA
State	:	FL
Zip	:	33547-2853
Country	:	US
Telephone Number	:	813-699-1006
Fax Number	:	813-699-1012

Authorized Official
Title or Position	:	COO
Name	:	ELLEN MICHELLE BOWER
Credential	:
Telephone Number	:	813-286-2033

Provider Enumeration Date	:	12/22/2008
Last Update Date	:	05/09/2023

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