Provider Demographics
NPI:1043577257
Name:LEES SUMMIT CENTER FOR WOMENS WELLNESS, LLC
Entity Type:Organization
Organization Name:LEES SUMMIT CENTER FOR WOMENS WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MALAIKA
Authorized Official - Middle Name:N
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-806-7006
Mailing Address - Street 1:3600 NE RALPH POWELL RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-2369
Mailing Address - Country:US
Mailing Address - Phone:816-888-5200
Mailing Address - Fax:816-888-5210
Practice Address - Street 1:3600 NE RALPH POWELL RD
Practice Address - Street 2:SUITE A
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-2369
Practice Address - Country:US
Practice Address - Phone:816-888-5200
Practice Address - Fax:816-888-5210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center