CONTEMPORARY OBSTETRICS & GYNECOLOGY WOMENS CARE CENTER LLC - NPI NUMBER 1780017426

Summary

Provider Name: CONTEMPORARY OBSTETRICS & GYNECOLOGY WOMENS CARE CENTER LLC

NPI Number: 1780017426

Clasification: Clinic/Center (261QM2500X)

Specialization: Medical Specialty

Address:
4322 7TH ST
MOLINE, IL
ZIP 61265

Phone Number: (309) 517-6222



Detailed Information

CONTEMPORARY OBSTETRICS & GYNECOLOGY WOMENS CARE CENTER LLC is a medical specialty clinic/center in Moline, IL. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). The assigned NPI number for this provider is 1780017426 and is registered as an organization entity type.

The provider's business address is:

4322 7TH ST
MOLINE, IL
ZIP 61265-867
Phone: (309) 517-6222
Fax: (309) 517-6227

The provider's authorized official is May Yazeji .
The authorized official title is Physician and has the following contact phone number (309) 696-5420.

The enumeration date for this NPI number is 8/16/2013 and was last updated on 11/11/2013.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 261QM2500X Clinic/Center Medical Specialty 036116849 IL Yes

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1780017426 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name CONTEMPORARY OBSTETRICS & GYNECOLOGY WOMENS CARE CENTER LLC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider First Line Business Practice Location Address 4322 7TH ST The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
6 Provider Business Practice Location Address City Name MOLINE The city name in the location address of the provider being identified.
7 Provider Business Practice Location Address State Name IL The State code in the location of the provider being identified.
8 Provider Business Practice Location Address Postal Code 612656867 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
9 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
10 Provider Business Practice Location Address Telephone Number 3095176222 The telephone number associated with the location address of the provider being identified.
11 Provider Business Practice Location Address Fax Number 3095176227 The fax number associated with the location address of the provider being identified.
12 Provider Enumeration Date 8/16/2013 The date the provider was assigned a unique identifier (assigned an NPI).
13 Last Update Date 11/11/2013 The date that a record was last updated or changed.
14 Authorized Official Last Name YAZEJI The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
15 Authorized Official First Name MAY The first name of the authorized official.
16 Authorized Official Title or Position PHYSICIAN The title or position of the authorized official.
17 Authorized Official Telephone Number 3096965420 The 10-position telephone number of the authorized official.
18 Healthcare Provider Taxonomy Code 1 261QM2500X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
19 Provider License Number 1 036116849 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
20 Provider License Number State Code 1 IL The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Is Organization Subpart N
23 Authorized Official Name Prefix Text DR.
24 Authorized Official Credential Text MD

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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