1164592960 NPI number — THE WOMEN'S CLINIC, A MEDICAL CORPORATION

Table of content: (NPI 1164592960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164592960 NPI number — THE WOMEN'S CLINIC, A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE WOMEN'S CLINIC, A MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MINDEN LADIES RURAL HEALTH CLINIC, LLC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164592960
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
431 HOMER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINDEN
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71055-2933
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-377-8855
Provider Business Mailing Address Fax Number:
318-371-1160

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
427 HOMER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINDEN
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71055-2933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-377-8855
Provider Business Practice Location Address Fax Number:
318-377-8804
Provider Enumeration Date:
11/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FOSTER
Authorized Official First Name:
PENNY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
318-377-8855

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1108294 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 19-3879 . This is a "MEDICARE CCN" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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