Provider Demographics
NPI:1861621195
Name:WOMENS CENTER OF HYDE PARK LLC
Entity type:Organization
Organization Name:WOMENS CENTER OF HYDE PARK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:PENDERGRAFT
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:813-258-5995
Mailing Address - Street 1:502 S MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2257
Mailing Address - Country:US
Mailing Address - Phone:813-258-5995
Mailing Address - Fax:813-253-3330
Practice Address - Street 1:502 S MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2257
Practice Address - Country:US
Practice Address - Phone:813-258-5995
Practice Address - Fax:813-253-3330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty