Basic Information
| Provider Information | |||||||||
| NPI: | 1093248015 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE KANE CLINIC'S, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | INTERNATIONAL WOMENS HEALTH SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 CLEARVIEW AVE | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | DORAVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303402100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042504447 | ||||||||
| FaxNumber: | 7704513343 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 CLEARVIEW AVE | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | DORAVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303402100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042504447 | ||||||||
| FaxNumber: | 7704513343 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2017 | ||||||||
| LastUpdateDate: | 04/06/2017 | ||||||||
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| AuthorizedOfficialLastName: | ARRIAZA | ||||||||
| AuthorizedOfficialFirstName: | ANA | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLER | ||||||||
| AuthorizedOfficialTelephone: | 4042504447 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics |
ID Information
| ID | Type | State | Issuer | Description | 003145697A | 05 | GA | MEDICAID |