Basic Information
| Provider Information | |||||||||
| NPI: | 1205923430 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STARK COUNTY WOMEN'S CLINIC INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 HIGBEE AVE NW | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447182522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304930313 | ||||||||
| FaxNumber: | 3304939349 | ||||||||
| Practice Location | |||||||||
| Address1: | 5000 HIGBEE AVE NW | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447182522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304930313 | ||||||||
| FaxNumber: | 3304939349 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2006 | ||||||||
| LastUpdateDate: | 05/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | STARCHER | ||||||||
| AuthorizedOfficialFirstName: | RANDALL | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 3304930313 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0336407 | 05 | OH | MEDICAID |