Provider Demographics
NPI:1366483315
Name:WOMAN'S SPECIALTY CLINIC
Entity Type:Organization
Organization Name:WOMAN'S SPECIALTY CLINIC
Other - Org Name:WOMAN'S SPECIALTY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO AND PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERI
Authorized Official - Middle Name:G
Authorized Official - Last Name:FONTENOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-927-1300
Mailing Address - Street 1:500 RUE DE LA VIE ST STE 311
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-5128
Mailing Address - Country:US
Mailing Address - Phone:225-924-8550
Mailing Address - Fax:225-924-8647
Practice Address - Street 1:500 RUE DE LA VIE ST
Practice Address - Street 2:SUITE 515
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-5127
Practice Address - Country:US
Practice Address - Phone:225-924-8550
Practice Address - Fax:225-924-8647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1444677Medicaid
LA1444677Medicaid