Provider Demographics
NPI:1003843210
Name:THE WOMANS CLINIC OF MS PLLC
Entity Type:Organization
Organization Name:THE WOMANS CLINIC OF MS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:FANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-354-0869
Mailing Address - Street 1:501 MARSHALL ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-1687
Mailing Address - Country:US
Mailing Address - Phone:601-354-0869
Mailing Address - Fax:601-352-6521
Practice Address - Street 1:501 MARSHALL ST
Practice Address - Street 2:SUITE 400
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-1687
Practice Address - Country:US
Practice Address - Phone:601-354-0869
Practice Address - Fax:601-352-6521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty