Provider Demographics
NPI:1073935078
Name:KLAMATH WOMEN'S CENTER, LLC
Entity Type:Organization
Organization Name:KLAMATH WOMEN'S CENTER, LLC
Other - Org Name:BABY CATCHERS AND COMPANY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:STAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:NP, CNM
Authorized Official - Phone:541-887-8321
Mailing Address - Street 1:1900 MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-2629
Mailing Address - Country:US
Mailing Address - Phone:541-887-8321
Mailing Address - Fax:541-887-8322
Practice Address - Street 1:1900 MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-2629
Practice Address - Country:US
Practice Address - Phone:541-887-8321
Practice Address - Fax:541-887-8322
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KLAMATH WOMEN'S CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-09
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
OR07-1630261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500671711Medicaid
OR085311Medicaid
OR500671713Medicaid