Provider Demographics
NPI:1164592960
Name:THE WOMEN'S CLINIC, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:THE WOMEN'S CLINIC, A MEDICAL CORPORATION
Other - Org Name:MINDEN LADIES RURAL HEALTH CLINIC, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:M
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-377-8855
Mailing Address - Street 1:431 HOMER RD
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-2933
Mailing Address - Country:US
Mailing Address - Phone:318-377-8855
Mailing Address - Fax:318-371-1160
Practice Address - Street 1:427 HOMER RD
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-2933
Practice Address - Country:US
Practice Address - Phone:318-377-8855
Practice Address - Fax:318-377-8804
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE WOMEN'S CLINIC, A MEDICAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-09
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1108294Medicaid
LA19-3879OtherMEDICARE CCN