Provider Demographics
NPI:1376767178
Name:LOGANSPORT CLINIC FOR WOMEN
Entity Type:Organization
Organization Name:LOGANSPORT CLINIC FOR WOMEN
Other - Org Name:WOMEN'S HEALTH CENTER OF LOGANSPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE COMPLIANCE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELLIOT
Authorized Official - Suffix:
Authorized Official - Credentials:CHC
Authorized Official - Phone:574-753-1767
Mailing Address - Street 1:1025 MICHIGAN AVE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-1593
Mailing Address - Country:US
Mailing Address - Phone:574-722-3566
Mailing Address - Fax:574-753-6118
Practice Address - Street 1:1025 MICHIGAN AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-1593
Practice Address - Country:US
Practice Address - Phone:574-722-3566
Practice Address - Fax:574-753-6118
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-12
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN111880EMedicare ID - Type Unspecified
IN940670VVVVMedicare PIN
IN111880BMedicare ID - Type Unspecified
IN940670XXXXMedicare PIN
ING42783Medicare UPIN
IN940670ZZZZMedicare PIN
ING43330Medicare UPIN
INC24402Medicare UPIN
IN111880FMedicare ID - Type Unspecified
IN940670A1Medicare PIN
IN111880Medicare ID - Type Unspecified
INB95753Medicare UPIN