Active NPI
Innovative Women'S Healthcare, PLLC
- Multi-Specialty Clinic/Center
- Maryville, IL
National Provider Identifier
1104535335
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Multi-Specialty Clinic/Center
- Legal business name
- INNOVATIVE WOMEN'S HEALTHCARE, PLLC
- Practice address
- 2016 Vadalabene Dr Ste D
Maryville, IL 62062-6901 - Phone
- (618) 444-5475
- NPI assigned
- Nov 16, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Tamara Kaye Young, CNM, PMHNP-BC
- Title
- Owner/Manager
- Phone
- (618) 444-5475
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Multi-Specialty Clinic/Center | 261QM1300X | Primary |
Addresses
Primary practice location
2016 Vadalabene Dr Ste D
Maryville, IL 62062-6901
Mailing address
1087 Il Route 127
Greenville, IL 62246-3041
Phone (618) 444-5475
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
National Provider Directory
National Provider DirectoryLocations
1365 E Union Ave
Litchfield, IL 62056
Phone (618) 391-7030
2016 Vadalabene Dr
Ste D
Maryville, IL 62062
Phone (618) 391-7030
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Psychiatric/Mental Health Nurse Practitioner
- Litchfield, IL
- NPI 1356169783
-
- Psychiatric/Mental Health Nurse Practitioner
- Saint Louis, MO
- NPI 1417688615
IL
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1668556800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1668556800000",
"number": "1104535335",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1087 IL ROUTE 127",
"city": "GREENVILLE",
"state": "IL",
"postal_code": "622463041",
"telephone_number": "618-444-5475"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2016 VADALABENE DR STE D",
"city": "MARYVILLE",
"state": "IL",
"postal_code": "620626901",
"telephone_number": "618-444-5475"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "INNOVATIVE WOMEN'S HEALTHCARE, PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2022-11-16",
"last_updated": "2022-11-16",
"certification_date": "2022-11-16",
"status": "A",
"authorized_official_last_name": "YOUNG",
"authorized_official_first_name": "TAMARA",
"authorized_official_middle_name": "KAYE",
"authorized_official_title_or_position": "OWNER/MANAGER",
"authorized_official_telephone_number": "618-444-5475",
"authorized_official_name_prefix": "Mrs.",
"authorized_official_credential": "CNM, PMHNP-BC"
},
"taxonomies": [
{
"code": "261QM1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Multi-Specialty",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Maryville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.