Provider Demographics
NPI:1083767487
Name:WOMEN FIRST, PC
Entity Type:Organization
Organization Name:WOMEN FIRST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:CLONINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:573-339-1101
Mailing Address - Street 1:1111 N MOUNT AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-3437
Mailing Address - Country:US
Mailing Address - Phone:573-339-1101
Mailing Address - Fax:573-339-1737
Practice Address - Street 1:1111 N MOUNT AUBURN RD
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-3437
Practice Address - Country:US
Practice Address - Phone:573-339-1101
Practice Address - Fax:573-339-1737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000094819Medicare PIN
MO000000545Medicare PIN
MO990001451Medicare ID - Type Unspecified
MO000009360Medicare PIN