| Innovative Women's Healthcare, Pllc | |
|
2016 Vadalabene Dr Ste D Maryville IL 62062-6901 | |
| (618) 444-5475 | |
| Not Available |
| Full Name | Innovative Women's Healthcare, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2016 Vadalabene Dr Ste D, Maryville, Illinois |
| Authorized Official Name and Position | Tamara Kaye Young (OWNER/MANAGER) |
| Authorized Official Contact | 6184445475 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Women's Healthcare, Pllc 1087 Il Route 127 Greenville IL 62246-3041 Ph: (618) 444-5475 | Innovative Women's Healthcare, Pllc 2016 Vadalabene Dr Ste D Maryville IL 62062-6901 Ph: (618) 444-5475 |
| NPI Number | 1104535335 |
|---|---|
| Provider Enumeration Date | 11/16/2022 |
| Last Update Date | 11/16/2022 |
| Medicare PECOS PAC ID | 7719342187 |
|---|---|
| Medicare Enrollment ID | O20230509000314 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104535335 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Tamara K Young |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1740317510 PECOS PAC ID: 3274586607 Enrollment ID: I20050225000483 |
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