Provider Demographics
NPI:1073668406
Name:INDEPENDENCE WOMEN'S CLINIC
Entity Type:Organization
Organization Name:INDEPENDENCE WOMEN'S CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:K
Authorized Official - Last Name:GUTKNECHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-478-0220
Mailing Address - Street 1:19550 E 39TH ST S
Mailing Address - Street 2:SUITE 300
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2303
Mailing Address - Country:US
Mailing Address - Phone:816-478-0220
Mailing Address - Fax:816-795-3456
Practice Address - Street 1:19550 E 39TH ST S
Practice Address - Street 2:SUITE 300
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2303
Practice Address - Country:US
Practice Address - Phone:816-478-0220
Practice Address - Fax:816-795-3456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO500471404Medicaid
MO1490000Medicare PIN