Provider Demographics
NPI:1215017447
Name:PADUCAH WOMEN'S CLINIC PSC
Entity Type:Organization
Organization Name:PADUCAH WOMEN'S CLINIC PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARDENAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-443-8425
Mailing Address - Street 1:PO BOX 8148
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-8148
Mailing Address - Country:US
Mailing Address - Phone:270-443-8425
Mailing Address - Fax:270-442-3303
Practice Address - Street 1:2311 KY AVE
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-8148
Practice Address - Country:US
Practice Address - Phone:270-443-8425
Practice Address - Fax:270-442-3303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65918658Medicaid
KY65918658Medicaid