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Organization

A WOMANS PLACE INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. BELINDA J DUST (OWNER PRESIDENT)
(815) 744-9052
Entity
Organization

Contact information

Practice address
2614 W JEFFERSON ST, JOLIET, IL 60435-6433
(815) 744-9052
(815) 744-9389
Mailing address
2614 W JEFFERSON ST, JOLIET, IL 60435-6433
(815) 744-9052
(815) 744-9389

Taxonomy

Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000222495
BLUE CROSS BLUE SHEILD
IN
Enumeration date
06/12/2007
Last updated
08/29/2008
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