Provider Demographics
NPI:1407185689
Name:KLAMATH WOMEN'S CLINIC,LLC
Entity Type:Organization
Organization Name:KLAMATH WOMEN'S CLINIC,LLC
Other - Org Name:KLAMATH WOMEN'S CLINIC & BIRTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MEEK
Authorized Official - Suffix:
Authorized Official - Credentials:NP, CNM
Authorized Official - Phone:541-205-6262
Mailing Address - Street 1:1803 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-2636
Mailing Address - Country:US
Mailing Address - Phone:541-205-6262
Mailing Address - Fax:541-205-6499
Practice Address - Street 1:1803 MAIN ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-2636
Practice Address - Country:US
Practice Address - Phone:541-205-6262
Practice Address - Fax:541-205-6499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201394699DP261QB0400X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR155732Medicare PIN