Basic Information
| Provider Information | |||||||||
| NPI: | 1962659508 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CLINIC FOR WOMEN PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 910 ADAMS ST SE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358013730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565337420 | ||||||||
| FaxNumber: | 2565364109 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 CHATEAU DR SW | ||||||||
| Address2: | SUITE 145 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358016436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565337420 | ||||||||
| FaxNumber: | 2568827858 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2008 | ||||||||
| LastUpdateDate: | 08/26/2008 | ||||||||
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| AuthorizedOfficialLastName: | WEST | ||||||||
| AuthorizedOfficialFirstName: | AUDREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2565337420 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CLINIC FOR WOMEN PA | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 8858 | AL | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 32719 | 01 | AL | MEDICARE | OTHER | 32722 | 01 | AL | MEDICARE | OTHER | 32723 | 01 | AL | MEDICARE | OTHER | 32724 | 01 | AL | MEDICARE | OTHER | 78543 | 01 | AL | MEDICARE | OTHER |