Provider Demographics
NPI:1023207735
Name:WOMEN'S HEALTH OF WINCHESTER PSC
Entity Type:Organization
Organization Name:WOMEN'S HEALTH OF WINCHESTER PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEVENGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-523-6695
Mailing Address - Street 1:225 HOSPITAL DR
Mailing Address - Street 2:BLDG B, STE 255
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-7676
Mailing Address - Country:US
Mailing Address - Phone:859-744-2623
Mailing Address - Fax:859-744-9421
Practice Address - Street 1:225 HOSPITAL DR
Practice Address - Street 2:BLDG B, STE 255
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-7676
Practice Address - Country:US
Practice Address - Phone:859-744-2623
Practice Address - Fax:859-744-9421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207V00000X, 367A00000X
KY1051070363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Single Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000049460OtherBCBS
KY18D0687913OtherCLIA
KY64220569Medicaid
KY000000049460OtherBCBS
KY64220569Medicaid
KYK096040Medicare PIN
KYCH3029Medicare PIN