Basic Information
| Provider Information | |||||||||
| NPI: | 1023207735 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOMEN'S HEALTH OF WINCHESTER PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 HOSPITAL DR | ||||||||
| Address2: | BLDG B, STE 255 | ||||||||
| City: | WINCHESTER | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403917676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8597442623 | ||||||||
| FaxNumber: | 8597449421 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 HOSPITAL DR | ||||||||
| Address2: | BLDG B, STE 255 | ||||||||
| City: | WINCHESTER | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403917676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8597442623 | ||||||||
| FaxNumber: | 8597449421 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2007 | ||||||||
| LastUpdateDate: | 05/04/2020 | ||||||||
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| AuthorizedOfficialLastName: | CLEVENGER | ||||||||
| AuthorizedOfficialFirstName: | JOY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 5025236695 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0001X | 1051070 | KY | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology | 367A00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 207V00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 000000049460 | 01 | KY | BCBS | OTHER | 18D0687913 | 01 | KY | CLIA | OTHER | 64220569 | 05 | KY | MEDICAID |