Provider Demographics
NPI:1700976917
Name:ADVANCED WOMENS CARE CENTER SC
Entity type:Organization
Organization Name:ADVANCED WOMENS CARE CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANAE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:YOCKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:847-981-3698
Mailing Address - Street 1:800 BIESTERFIELD RD
Mailing Address - Street 2:EBERLE MEDICAL BUILDING #750
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3361
Mailing Address - Country:US
Mailing Address - Phone:847-981-3698
Mailing Address - Fax:847-981-3625
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:EBERLE MEDICAL BUILDING #750
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3361
Practice Address - Country:US
Practice Address - Phone:847-981-3698
Practice Address - Fax:847-981-3625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1073509451OtherNPI
IL1628269OtherBCBS OF IL
IL036089219Medicaid
IL209847Medicare PIN